Singapore National Eye Centre, Singapore.
Singapore Eye Research Institute, Singapore.
Clin Exp Ophthalmol. 2018 Aug;46(6):593-599. doi: 10.1111/ceo.13140. Epub 2018 Jan 12.
The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening.
Elderly individuals from low socio-economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow-up after community eye screening.
Randomized controlled trial in a population-based setting was conducted.
A total of 140 elderly individuals with VI (visual acuity <6/12, mean age ± SD = 66.6 ± 8.9 years, 46.4% female) were included.
Participants were randomized to either ICS (N = 72) or usual care (UC; N = 68). ICS incorporated patient education, social support and financial assistance to assist individuals in attending tertiary eye care. UC comprised of a standard referral letter and advice.
Primary outcome included compliance to eye care referral. Secondary outcomes included best-corrected visual acuity and vision-related quality of life assessed at baseline and 3 months.
Participants receiving the ICS intervention had higher rates of compliance to tertiary eye care attendance compared to UC (31.9% vs. 16.2%, respectively, P = 0.027). While we observed an overall significant improvement in best-corrected visual acuity at 3 months in both groups (P < 0.05), we found no significant differences in Rasch-transformed vision-related quality of life scores between groups (all P > 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial- and health-related barriers.
Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI.
该新干预措施在提高社区眼筛后接受适当的三级眼科保健的依从性方面是有效的。
来自社会经济背景较低的老年人群体，如果存在视力障碍（VI），即使在社区中发现了严重的眼部疾病，他们也往往不去接受三级保健。我们评估了一种新的激励保健计划（ICS），以提高社区眼筛后适当随访的依从性。
在基于人群的环境中进行了随机对照试验。
共纳入了 140 名 VI 老年患者（视力 <6/12，平均年龄 ± 标准差=66.6 ± 8.9 岁，46.4%为女性）。
参与者被随机分配到 ICS（n=72）或常规护理（UC；n=68）组。ICS 包括患者教育、社会支持和经济援助，以帮助患者接受三级眼科保健。UC 包括标准转诊信和建议。
主要观察指标是对眼科保健转诊的依从性。次要观察指标包括基线和 3 个月时的最佳矫正视力和与视力相关的生活质量。
与 UC 组相比，接受 ICS 干预的患者三级眼科保健就诊的依从性更高（分别为 31.9%和 16.2%，P=0.027）。虽然我们发现两组的最佳矫正视力在 3 个月时均有显著提高（均 P <0.05），但两组间 Rasch 转化后的与视力相关的生活质量评分无显著差异（均 P >0.05）。三级医疗保健获取的障碍包括患者态度以及经济和健康相关的障碍。
我们的小型 RCT 发现，ICS 提高了 VI 老年患者社区眼筛后接受适当的三级眼科保健转诊的依从性。
