School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Ophthalmic Physiol Opt. 2021 Jul;41(4):782-797. doi: 10.1111/opo.12801. Epub 2021 Mar 28.
Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery.
PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling.
The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.
循证实践是提供高质量护理、患者满意度和合理利用有限医疗保健资源的基础。然而，据报道，循证眼科护理的实施存在差异。鉴于验光师在提供初级眼科护理方面的重要作用，需要更好地了解提供眼科护理的障碍和促进因素。本系统评价旨在确定验光师提供眼科护理的决定因素（障碍和促进因素），以及可能改善眼科护理提供的干预措施。
在 1999 年至 2020 年期间，检索了 PubMed、MEDLINE、EMBASE、CINAHL、SCOPUS、PsychINFO、ProQuest 和 Web of Science 中报道眼科护理障碍和促进因素的研究。使用理论领域框架（TDF）分析数据（引文、解释性摘要、调查结果），将障碍和促进因素编码为一个或多个 14 个领域，用于根据编码频率、阐述和研究中的重要性确定影响眼科护理提供的关键行为领域。有影响力的领域被映射到行为改变轮，以确定改善眼科护理提供的潜在干预措施。从搜索中检索到的 802 篇研究中，有 30 篇被纳入。经常被识别的障碍包括时间限制、资源和设备问题、患者因素、缺乏意识、技能熟练程度不足以及负面态度和信念。经常被识别的促进因素包括充足的时间、资源和设备、教育、技能熟练程度以及理解所提供的眼科护理的相关性。影响眼科护理提供的关键 TDF 领域包括“环境背景和资源”（时间、资源、设备问题、患者因素）、“知识”（意识问题）、“技能”（技能熟练程度）和“对后果的信念”（信念和相关性）。可能改善眼科护理提供的干预功能包括教育、培训、限制、环境重构、赋权、说服和建模。
本研究中确定的障碍和促进因素多种多样，存在于医生和组织层面。发现四个 TDF 领域是眼科实践的重要决定因素。本研究中确定的干预功能可用于提高初级眼科护理的适宜性。
