College of Ophthalmology and Allied Visual Sciences (COAVS), Mayo Hospital, King Edward Medical University, Lahore, Pakistan.
National Committee for Eye Health, Government of Pakistan, Islamabad, Pakistan.
Front Public Health. 2022 Jul 22;10:873192. doi: 10.3389/fpubh.2022.873192. eCollection 2022.
Over one billion people worldwide live with avoidable blindness or vision impairment. Eye Health Programmes tackle this by providing screening, primary eye care, refractive correction, and referral to hospital eye services. One point where patients can be lost in the treatment journey is adherence to hospital referral.
Peek Vision's software solutions have been used in Pakistan with the goal of increasing eye health programme coverage and effectiveness. This involved collaboration between health system stakeholders, international partners, local community leaders, social organizers and "Lady Health Workers".
From the beginning of the programmes in November 2018, to the end of December 2021, 393,759 people have been screened, 26% of whom ( = 101,236) needed refractive services or secondary eye care, and so were referred onwards to the triage centers or hospital services. Except for a short period affected heavily by COVID-19 pandemic, the programmes reached an increasing number of people over time: screening coverage improved from 774 people per month to over 28,300 people per month. Gathering and discussing data regularly with stakeholders and implementers has enabled continuous improvement to service delivery. The quality of screening and adherence to hospital visits, gender balance differences and waiting time to hospital visits were also improved. Overall attendance to hospital appointments improved in 2020 compared to 2019 from 45% (95% CI: 42-48%) to 78% (95% CI: 76-80%) in women, and from 48% (95% CI: 45-52%) to 70% (95% CI: 68-73%) in men. These patients also accessed treatment more quickly: 30-day hospital referral adherence improved from 12% in 2019 to 66% in 2020. This approach helped to utilize refractive services more efficiently, reducing false positive referrals to triage from 10.6 to 5.9%. Hospital-based services were also utilized more efficiently, as primary eye care services and refractive services were mainly delivered at the primary healthcare level.
Despite various challenges, we demonstrate how data-driven decisions can lead to health programme systems changes, including patient counseling and appointment reminders, which can effectively improve adherence to referral, allowing programmes to better meet their community's needs.
全球有超过 10 亿人生活在可避免的失明或视力损伤之中。眼保健计划通过提供筛查、初级眼保健、屈光矫正和转诊至医院眼科服务来解决这一问题。患者在治疗过程中可能会失去联系的一个关键点是对医院转诊的坚持。
Peek Vision 的软件解决方案已在巴基斯坦使用，目的是提高眼保健计划的覆盖范围和效果。这涉及卫生系统利益相关者、国际合作伙伴、当地社区领袖、社会组织者和“Lady Health Workers”之间的合作。
从 2018 年 11 月项目开始到 2021 年 12 月底，已有 393759 人接受了筛查，其中 26%（即 101236 人）需要屈光服务或二级眼保健，因此被转诊到分诊中心或医院服务。除了受 COVID-19 大流行严重影响的短时间外，随着时间的推移，该计划覆盖的人数不断增加：筛查覆盖率从每月 774 人提高到每月 28300 人以上。与利益相关者和执行者定期收集和讨论数据，使得服务提供得以持续改进。筛查质量和对医院就诊的坚持、性别平衡差异以及就诊的等待时间也得到了改善。与 2019 年相比，2020 年女性整体到医院就诊预约的比例从 45%（95%CI：42-48%）提高到 78%（95%CI：76-80%），男性从 48%（95%CI：45-52%）提高到 70%（95%CI：68-73%）。这些患者也能更快地获得治疗：30 天医院转诊坚持率从 2019 年的 12%提高到 2020 年的 66%。这种方法有助于更有效地利用屈光服务，将分诊的假阳性转诊从 10.6%降至 5.9%。医院为基础的服务也得到了更有效的利用，因为初级眼保健服务和屈光服务主要在初级医疗保健层面提供。
尽管面临各种挑战，我们证明了数据驱动决策如何能够导致健康计划系统的变化，包括患者咨询和预约提醒，这可以有效地提高转诊的坚持率，使计划能够更好地满足社区的需求。
