一项改善中国学龄前儿童视力筛查后转诊依从性的综合干预措施的效果：一项整群随机临床试验。
Effect of a complex intervention to improve post-vision screening referral compliance among pre-school children in China: A cluster randomized clinical trial.
作者信息
Zeng Yangfa, Han Xiaotong, Wang Decai, Chen Shida, Zheng Yingfeng, Jiang Yuzhen, Chen Xiang, Li Yuting, Jin Ling, Chen Qianyun, Liang Xiaoling, Zhang Xiulan, Congdon Nathan, Liu Yizhi
机构信息
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, UK.
出版信息
EClinicalMedicine. 2020 Feb 4;19:100258. doi: 10.1016/j.eclinm.2020.100258. eCollection 2020 Feb.
BACKGROUND
We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening.
METHODS
We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT03251456.
FINDINGS
Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%, < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36-1·72), travel time to hospital (RR: 0·97, 0·95-0·999), baseline glasses wear (RR: 1·37, 1·17-1·60), strabismus (RR: 1·17, 1·01-1·36) and worse uncorrected vision (RR: 1·41, 1·03-1·92) were associated with compliance.
INTERPRETATION
Providing specific appointments for quality-assured eye care improved referral compliance in this setting.
背景
我们调查了在中国儿童视力筛查中，保证质量的特定预约是否能提高转诊接受率，而在中国转诊接受率通常较低。
方法
在中国江西于都，我们按学校将4至7岁的儿童随机分为对照组（进行免费的校内视力筛查，建议筛查未通过的儿童家长进行进一步检查[常规做法]）或干预组（进行相同的检查，另外为家长提供由当地指定医院有资质的医生进行进一步检查的特定预约）。两组都可以选择任何医院进行转诊检查，这些检查并非免费。筛查6个月后，对家长进行访谈，了解他们在任何医院的转诊依从性（主要结局）以及潜在决定因素。该试验已在ClinicalTrials.gov注册，注册号为NCT03251456。
结果
在随机分配到干预组（32所学校，5053名[50.9%]儿童）或对照组（31所学校，4883名[49.1%]儿童）的63所学校的9936名儿童中，1114名儿童（11.2%）筛查未通过。在513名转诊的干预组儿童（46.1%，32所学校，平均年龄5.36岁，53.0%为男孩）和601名转诊的对照组儿童（53.9%，31所学校，平均年龄5.30岁，57.7%为男孩）中，分别有104名（20.3%）和135名（22.5%）失访。在意向性分析中，假设失访儿童不依从，干预组儿童的依从性显著高于对照组（308/513 = 60.0% 对 225/601 = 37.4%，P < 0.001）。在回归模型中，干预组（相对风险[RR] 1.53，95%置信区间，1.36 - 1.72）、到医院的出行时间（RR：0.97，0.95 - 0.999）、基线眼镜佩戴情况（RR：1.37，1.17 - 1.60）、斜视（RR：1.17，1.01 - 1.36）以及较差的未矫正视力（RR：1.41，1.03 - 1.92）与依从性相关。
解读
在这种情况下，提供保证质量的眼部护理特定预约可提高转诊依从性。
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