《增强尼泊尔瑞友会惠光眼科医院糖尿病患者视网膜服务转诊途径：一项非随机、干预前后研究》
"Augmenting the referral pathway for retinal services among diabetic patients at Reiyukai Eiko Masunaga Eye Hospital, Nepal: a non-randomized, pre-post intervention study".
机构信息
Reiyukai Eiko Masunaga Eye Hospital, Banepa, Kavre, Nepal.
SEVA Foundation, Kathmandu, Nepal.
出版信息
BMC Health Serv Res. 2023 Feb 8;23(1):126. doi: 10.1186/s12913-023-09105-3.
BACKGROUND
Diabetic Retinopathy (DR) is an important public health issue in Nepal. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. DR screening uptake was low at Reiyukai Eiko Masunaga Eye Hospital(REMEH) since retina services were started. Scheer Memorial Hospital is a multispeciality hospital near to REMEH. It has no eye department but has been running a regular diabetic clinic. This was a site for referring diabetic patients for DR screening. Improving DR awareness among general physicians has the potential to address these challenges.
METHODS
The aim of our study was to investigate the effectiveness of providing health education to selected health personnel and establish a referral pathway on the attendance of diabetic patients for retinal screening at REMEH. This was a non-randomized, pre-post intervention study design. Total of three health education sessions were provided to the health care professionals of Scheer on diabetic retinopathy using Power Point presentations, posters, pamphlets and videos. The study period was 16 months (2020 June -2021 September) and divided into 8 months pre-intervention(baseline data collection) and 8 months post intervention period. The proportional increase in number of diabetes attendance pre and post intervention was calculated by Z test. The change in knowledge of health care personnels pre and post intervention was scored and evaluated through a questionnaire and calculated by paired- t test. Data was analyzed using Excel and Epi Info 7.The Protocol was published on August 21, 2021, in JMIR Publications.
RESULTS
The proportional increase in number of referrals of diabetes attendance post intervention increased from 50 to 95% and was statistically significant (p < 0.001, 95% CI: 0.214-0.688). The mean score of knowledge gained by physicians on DR awareness was more at post intervention (8.8 ± 1.32) than pre intervention (6.4 ± 1.51). It was statistically significant (p < 0.001).
CONCLUSION
This study shows that a well-planned health education intervention changes the knowledge in physicians about DR. There is an increase in the number of referrals and attendance of patients for DR screening with the change in knowledge and referral mechanism.
TRIAL REGISTRATION
Clinical Trials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 :02/04/2021.
背景
糖尿病视网膜病变（DR）是尼泊尔的一个重要公共卫生问题。尽管有视网膜服务，但由于对 DR 的认识不足和转诊系统不佳，人们可能无法获得这些服务。自雷尤凯伊荣子眼医院（REMEH）开展视网膜服务以来，DR 筛查的参与率一直很低。舍尔纪念医院是 REMEH 附近的一家多专科医院。它没有眼科部门，但一直在开设常规糖尿病诊所。这是转诊糖尿病患者进行 DR 筛查的地点。提高普通医生对 DR 的认识有可能解决这些挑战。
方法
我们的研究目的是调查向选定的卫生人员提供健康教育并建立转诊途径对 REMEH 糖尿病患者视网膜筛查参与度的影响。这是一项非随机、干预前后研究设计。共向舍尔的卫生保健专业人员提供了 3 次关于糖尿病视网膜病变的健康教育课程，使用 Power Point 演示文稿、海报、小册子和视频。研究期间为 16 个月（2020 年 6 月至 2021 年 9 月），分为 8 个月的干预前（基线数据收集）和 8 个月的干预后。通过 Z 检验计算干预前后糖尿病就诊人数的比例增加。通过问卷调查和配对 t 检验评估干预前后卫生保健人员知识的变化，并计算得分。使用 Excel 和 Epi Info 7 分析数据。方案于 2021 年 8 月 21 日在 JMIR 出版物上发布。
结果
干预后转诊糖尿病就诊人数的比例从 50%增加到 95%，具有统计学意义（p<0.001，95%CI：0.214-0.688）。医生对 DR 意识的知识得分在干预后（8.8±1.32）高于干预前（6.4±1.51），具有统计学意义（p<0.001）。
结论
这项研究表明，精心策划的健康教育干预改变了医生对 DR 的认识。随着知识和转诊机制的改变，DR 筛查的转诊和患者就诊人数有所增加。
试验注册
ClinicalTrials.gov NCT04829084；https://clinicaltrials.gov/ct2/show/NCT04829084：2021 年 4 月 2 日。
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