Lumbini Eye Institute and Research center, Siddharthanagar, Lumbini, Nepal.
Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
BMC Health Serv Res. 2024 Feb 10;24(1):188. doi: 10.1186/s12913-024-10647-3.
Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal.
In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital.
We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p<0.05). Compliance was 43% (n=66) with counselling alone, and 66% (n=103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days).
Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal.
ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.
糖尿病视网膜病变（DR）是一个新出现的公共卫生问题，可导致严重的视力损害或失明。早期发现和及时治疗对于获得良好的视觉效果至关重要。本研究的目的是评估 SCREEN 方案在提高尼泊尔一家三级眼科中心从周边中心转诊的依从性方面的效果。
这是一项基于机构的整群随机试验，在尼泊尔卢比尼地区的一家三级眼科护理中心的 19 家转诊中心中，有 10 家被随机分为干预组和对照组。为需要在三级中心接受高级治疗的 DR 患者提供 SCREEN 方案作为干预措施，并与对照组的现行做法进行比较，对照组缺乏结构化咨询和随访机制。通过转诊中心和转诊医院之间的每周随访来评估依从性。
我们招募了 302 名参与者，其中 153 名在干预组。参与者的平均年龄为 57.8 岁（标准差 [SD]±11.7 岁）。在实施 SCREEN 方案后，干预组中有 71.2%（n=109）和对照组中有 42.9%（n=64）在三个月的随访中保持依从性（差异 28.3%，95%CI：17.6-39.0，p<0.05）。在干预组中，仅通过咨询的依从性为 43%（n=66），第一次电话随访的依从性为 66%（n=103）。到达转诊中心的平均时间为 14.7 天（SD±9.4 天）和干预组和对照组分别为 18.2 天（SD±9.1 天）（差异 3.5 天，95%CI：0.7 至 6.4 天）。
对患者进行咨询和随访是提高 DR 患者利用卫生服务的关键因素。尼泊尔必须通过优化现有的转诊结构来加强卫生系统。
ClinicalTrials.gov 方案注册和结果系统，ClinicalTrials.gov 标识符：NCT04834648，2021 年 8 月 4 日。
