The Need to Define Advocacy Within Optometry

As optometrists, we are committed to preserving and promoting overall health by providing comprehensive eye and vision care, which encompasses a spectrum of primary, secondary, and tertiary services. This is a complex charge not to be taken lightly, as it requires constant engagement, public education, and positive stakeholder and decision-maker relationships.

For those of us trained in additional specific disciplines of health care and whose research focuses on health care delivery, health outcomes, and health policy, the web of complexities surrounding the concept of health is well understood. Sharing expertise from these areas is relatively new and valuable, as it informs the profession and connects the “advocacy dots.” This is more essential than ever, as the majority of professionals are busy providing care 24/7 to their communities.

TWO KEY frameworks to understand HEALTH ADVOCACY

When it comes to advocacy, clinical guidelines and health measures are two important terms that help us stratify our thoughts.

Clinical Guidelines

A highly valuable and multipurpose advocacy focus involves the proper development and execution of evidence-based professional clinical practice guidelines.¹ In addition to building public support for legislative and policy actions that increasing scope of and access to optometric care, the clinical practice guidelines provide a comprehensive overview of appropriate processes for care that improve health, as well as a plethora of evidence for shared clinical decision-making and relevant research and outcomes data, to name a few uses.¹

Health Measures

Another fundamental aspect to advocacy advancement involves the use of certain health measures to ensure progress. Health measures can be grouped into one of three general categories: structure, process, and outcomes. These categories provide a basis for current knowledge and ongoing discovery in understanding what works in health care, which care processes are recommended and paid for, who should be involved, and why. Too often, this important follow-up is overlooked or not taken seriously. Therefore, one of our duties as modern optometrists is to demand accountability for resource allocation and future professional strategy.

There are many health measures to choose from, depending upon the need and desired outcome. For example, a contemporary health measure used to inform health care decision-making involves patient-reported outcomes (PROs) and, by extension, patient-reported outcome measures (PROMs).^1,2 PROMs are the tools used to capture patient reports of their outcomes. They are used as the basis for patient-reported outcome-based performance measures (PRO-PMs) and are high priority measures for the Centers for Medicare & Medicaid Services (CMS) and other organizations.^1,2

The CMS defines a PRO as “any report of the status of a patient’s health condition or health behavior that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.”¹ This definition reflects the three domains of health-related quality of life: functional status, symptoms and symptom burden (eg, pain, fatigue), and health behaviors (eg, smoking status, diet, exercise). Ensuring that patients and families are engaged as partners in their care is an effective way to measure the quality of patient care and provide professional feedback for action prioritization.

WHERE DO WE STAND?

Major professional US health care organizations recognize the need to advocate for their own members and related professional objectives. Below are statements on this subject from major organizations that influence our field.

• The American Osteopathic Association (AOA) states that, “from health care reform to graduate medical education funding, the AOA advocates on behalf of the osteopathic medical profession to advance legislative and regulatory improvements and promote access to care.”³
• The American Medical Association states that it advocates “at the federal and state levels on key health care issues impacting patients and physicians.”⁴
• The American Public Health Association, “in coordination with its members and state and regional Affiliates, works with key decisionmakers to shape public policy to address today’s ongoing public health concerns, [including] ensuring access to care, protecting funding for core public health programs and services and eliminating health disparities.”⁵
• The American Academy of Ophthalmology shares on its website what is done “in state and federal government affairs and health policy affecting ophthalmologists and patients,” providing a “Where We Stand” resource on “issues affecting members, patient care and the profession.”⁶
• The American Nurses Association “believes that advocacy is a pillar of nursing [as] nurses instinctively advocate for their patients, in their workplaces, and in their communities; but legislative and political advocacy is no less important to advancing the profession and patient care.”⁷
• The American Academy of Physician Associates “works to advance the profession and promote quality, accessibility and cost-effectiveness in patient-centered healthcare [including] initiatives related to the federal, state and grassroots levels.”⁸

Following is a brief review of professional optometry-specific entities and their approaches:

• The American Optometric Association states that it “is the only advocate for optometry” and divides its advocacy into subcategories of “federal, state, patient protection, and third party” on its website.⁹
• The American Academy of Optometry does not have a banner for advocacy or show a match for advocacy when searched on its website.¹⁰
• The Association of Regulatory Boards in Optometry states that, “advocacy serves to protect the profession of optometry and that regulatory serves to protect the public.”¹¹
• Under “Public Policy & Advocacy,” the Association of Schools and Colleges in Optometry states that it “encourages the involvement of leaders of our member institutions in public policy development and advocacy through our Government Affairs Committee and through ‘grass-tops’ activities at the school and college level.”¹²
• The Accreditation Council on Optometric Education in its mission statement, while not directly linked to the word “advocacy,” states that it “serves the public and the profession of optometry by establishing, maintaining and applying standards to ensure the academic quality and continuous improvement of optometric education that reflect the contemporary practice of optometry.”¹³

When we take a closer look at the highlighted optometry-related organizations, there is noticeable overlap, and some disconnect in terms of what is indicated—and what is not included. That is, among the optometric organizations, there are gaps with regard to how advocacy is defined, objectives that are enacted regarding health, and what constitutes contemporary practice in the greater sphere.

Although additional actions are also listed within the scope of many professional organizations’ activities, it is a bit unclear what supplementary objectives actually fall within the “advocacy realm” of the entity. This results in difficulty for both members and outside stakeholders in trying to reconcile 1) which professional advocacy priorities are excluded, included, and prioritized, 2) how subsequent financial and other resource supports are to be provided, and 3) how outcomes are evaluated to demonstrate advocacy success or failure. Of note, there is a lack of clarity about where health fits in. In other words, how is the professional “primary concern for patient health” as stated in the Optometric Oath¹⁴ prioritized, and where is its symbiosis with other important advocacy goals acknowledged?

TIME TO TAKE INITIATIVE

The question remains as to how health fits into the landscape described above. In the next part of this series, we will discuss contemporary examples and ideas for modern advocacy for day-to-day practice, patient care choices, and professional involvement. We will also further examine the intricacies of advocacy, including measures that can inform on progress.