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Shrestha R, Singh P, Dhakwa P, Tetali S, Batchu T, Thapa PS, Agiwal V, Pant H. "Augmenting the referral pathway for retinal services among diabetic patients at Reiyukai Eiko Masunaga Eye Hospital, Nepal: a non-randomized, pre-post intervention study". BMC Health Serv Res 2023; 23:126. [PMID: 36750897 PMCID: PMC9905012 DOI: 10.1186/s12913-023-09105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
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.
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Affiliation(s)
- Ruchi Shrestha
- Reiyukai Eiko Masunaga Eye Hospital, Banepa, Kavre, Nepal.
| | - Prerana Singh
- Reiyukai Eiko Masunaga Eye Hospital, Banepa, Kavre Nepal
| | | | - Shailaja Tetali
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | - Tripura Batchu
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | | | - Varun Agiwal
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
| | - Hira Pant
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health, Hyderabad, India
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Racine E, O Mahony L, Riordan F, Flynn G, Kearney PM, McHugh SM. What and how do different stakeholders contribute to intervention development? A mixed methods study. HRB Open Res 2022; 5:35. [PMID: 36895913 PMCID: PMC9989546 DOI: 10.12688/hrbopenres.13544.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background: UK Medical Research Council guidelines recommend end-user involvement in intervention development. There is limited evidence on the contributions of different end-users to this process. The aim of this Study Within A Trial (SWAT) was to identify and compare contributions from two groups of end-users - people with diabetes' (PWD) and healthcare professionals' (HCPs), during consensus meetings to inform an intervention to improve retinopathy screening uptake. Methods: A mixed method, explanatory sequential design comprising a survey and three semi-structured consensus meetings was used. PWD were randomly assigned to a diabetes only or combined meeting. HCPs attended a HCP only or combined meeting, based on availability. In the survey, participants rated intervention proposals on acceptability and feasibility. Survey results informed the meeting topic guide. Transcripts were analysed deductively to compare feedback on intervention proposals, suggestions for new content, and contributions to the final intervention. Results: Overall, 13 PWD and 17 HCPs completed the survey, and 16 PWD and 15 HCPs attended meetings. For 31 of the 39 intervention proposals in the survey, there were differences (≥10%) between the proportion of HCPs and PWD who rated proposals as acceptable and/or feasible. End-user groups shared and unique concerns about proposals; both were concerned about informing but not scaring people when communicating risk, while concerns about resources were mostly unique to HCPs and concerns about privacy were mostly unique to PWD. Fewer suggestions for new intervention content from the combined meeting were integrated into the final intervention as they were not feasible for implementation in general practice. Participants contributed four new behaviour change techniques not present in the original proposals: goal setting (outcome), restructuring the physical environment, material incentive (behaviour) and punishment. Conclusions: Preferences for intervention content may differ across end-user groups, with feedback varying depending on whether end-users are involved simultaneously or separately.
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Affiliation(s)
- Emmy Racine
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Lauren O Mahony
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Gráinne Flynn
- PPI Contributor, IDEAs Research Project, University College Cork, Cork, T12 K8AF, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
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Racine E, O Mahony L, Riordan F, Flynn G, Kearney PM, McHugh SM. What and how do different stakeholders contribute to intervention development? A mixed methods study. HRB Open Res 2022; 5:35. [PMID: 36895913 PMCID: PMC9989546 DOI: 10.12688/hrbopenres.13544.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Background: UK Medical Research Council guidelines recommend end-user involvement in intervention development. There is limited evidence on the contributions of different end-users to this process. The aim of this Study Within A Trial (SWAT) was to identify and compare contributions from two groups of end-users - people with diabetes' (PWD) and healthcare professionals' (HCPs), during consensus meetings to inform an intervention to improve retinopathy screening uptake. Methods: A mixed method, explanatory sequential design comprising a survey and three semi-structured consensus meetings was used. PWD were randomly assigned to a PWD only or combined meeting. HCPs attended a HCP only or combined meeting, based on availability. In the survey, participants rated intervention proposals on acceptability and feasibility. Survey results informed the meeting topic guide. Transcripts were analysed deductively to compare feedback on intervention proposals, suggestions for new content, and contributions to the final intervention. Results: Overall, 13 PWD and 17 HCPs completed the survey, and 16 PWD and 15 HCPs attended meetings. For 31 of the 39 intervention proposals in the survey, there were differences (≥10%) between the proportion of HCPs and PWD who rated proposals as acceptable and/or feasible. End-user groups shared and unique concerns about proposals; both were concerned about informing but not scaring people when communicating risk, while concerns about resources were mostly unique to HCPs and concerns about privacy were mostly unique to PWD. Fewer suggestions for new intervention content from the combined meeting were integrated into the final intervention as they were not feasible for implementation in general practice. Participants contributed four new behaviour change techniques not present in the original proposals: goal setting (outcome), restructuring the physical environment, material incentive (behaviour) and punishment. Conclusions: Preferences for intervention content may differ across end-user groups, with feedback varying depending on whether end-users are involved simultaneously or separately.
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Affiliation(s)
- Emmy Racine
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Lauren O Mahony
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Gráinne Flynn
- PPI Contributor, IDEAs Research Project, University College Cork, Cork, T12 K8AF, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, T12 K8AF, Ireland
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Shrestha R, Singh P, Dhakhwa P, Tetali S, Batchu T, Shrestha Thapa P. Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre-Post Intervention Study. JMIR Res Protoc 2021; 10:e33116. [PMID: 34927596 PMCID: PMC8726041 DOI: 10.2196/33116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Diabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges. Objective The aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal. Methods This is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7. Results The ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number # 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing. Conclusions Health education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal. Trial Registration ClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 International Registered Report Identifier (IRRID) DERR1-10.2196/33116
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Affiliation(s)
- Ruchi Shrestha
- Department of Vitreoretina, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
| | - Prerana Singh
- Department of Vitreoretina, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
| | | | - Shailaja Tetali
- Department of Research, Indian Institute of Public Health, Hyderabad, India
| | - Tripura Batchu
- Department of Research, Indian Institute of Public Health, Hyderabad, India
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Riordan F, Murphy A, Dillon C, Browne J, Kearney PM, Smith SM, McHugh SM. Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial. BMJ Open 2021; 11:e051951. [PMID: 34667010 PMCID: PMC8527153 DOI: 10.1136/bmjopen-2021-051951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Diabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects of an intervention to improve uptake of Ireland's national DRS programme, Diabetic RetinaScreen, among patients with type 1 or type 2 diabetes. DESIGN/SETTING We conducted a cluster randomised pilot trial, embedded process evaluation and cost analysis in general practice, July 2019 to January 2020. PARTICIPANTS Eight practices participated in the trial. For the process evaluation, surveys were conducted with 25 staff at intervention practices. Interviews were conducted with nine staff at intervention practices, and 10 patients who received the intervention. INTERVENTIONS The intervention comprised practice reimbursement, an audit of attendance, electronic prompts targeting professionals, General Practice-endorsed patient reminders and a patient information leaflet. Practices were randomly allocated to intervention (n=4) or wait-list control (n=4) (usual care). OUTCOMES Staff and patient interviews explored their perspectives on the intervention. Patient registration and attendance, including intention to attend, were measured at baseline and 6 months. Microcosting was used to estimate intervention delivery cost. RESULTS The process evaluation identified that enablers of feasibility included practice culture and capacity to protect time, systems to organise care, and staff skills, and workarounds to improve intervention 'fit'. At 6 months, 22/71 (31%) of baseline non-attenders in intervention practices subsequently attended screening compared with 15/87 (17%) in control practices. The total delivery cost across intervention practices (patients=363) was €2509, averaging €627 per practice and €6.91 per audited patient. Continuation criteria supported proceeding to a definitive trial. CONCLUSIONS The Improving Diabetes Eye screening Attendance intervention is feasible in primary care; however, consideration should be given to how best to facilitate local tailoring. A definitive trial of clinical and cost-effectiveness is required with preliminary results suggesting a positive effect on uptake. TRIAL REGISTRATION NUMBER NCT03901898.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | | | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
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Riordan F, Murphy K, Bradley C, Kearney PM, Smith SM, McHugh SM. Acceptability and feasibility of conducting a pilot trial in Irish primary care: lessons from the IDEAs study. HRB Open Res 2021; 4:73. [PMID: 35136854 PMCID: PMC8804907 DOI: 10.12688/hrbopenres.13306.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Understanding primary care practices’ ‘readiness’ to engage in trials and their experience is important to inform trial procedures and supports. Few studies report on the feasibility of study procedures though this is a central part of pilot trials. We explored the acceptability and feasibility of study procedures of a cluster randomised pilot trial of an intervention in primary care to improve uptake of Ireland’s national diabetic retinopathy programme. Methods As part of the embedded mixed-methods process evaluation, quantitative and qualitative data were gathered across four general practices participating in the intervention. Interviews were conducted with a purposive sample of staff. Research logs on time spent on intervention delivery, staff assignment, resources, problems/changes, and reasons for drop-outs, were maintained over the course of intervention rollout, and practice audit data were analysed. Quantitative outcomes included recruitment, retention, completion, and data quality and completeness. Qualitative data on perceptions and experience of the pilot trial procedures were analysed using the Framework Method. Findings Nine staff (3 GPs, 4 nurses, 2 administrators) were interviewed. An interest in the topic area or in research motivated practices to take part in the trial. Reimbursement meant they could ‘afford’ to participate. Staff valued the researcher briefing at the start of the trial, to avoid ‘going in slightly blind’. While staff varied in audit skills and confidence, and some found this aspect of data collection challenging, a ‘step-by-step’ audit manual and regular researcher contact, helped them stay on track and troubleshoot during data collection. Audit quality was acceptable overall, however there were some issues, incorrect assignment of patient status being most common. Conclusion The IDEAs trial procedures were acceptable and feasible for primary care staff, however, challenges with conducting the audit may reflect staff skills gaps and the need for greater guidance and support from researchers.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Katie Murphy
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kelly SR, Loiselle AR, Pandey R, Combes A, Murphy C, Kavanagh H, Fitzpatrick P, Mooney T, Kearney P, Crabb DP, Keegan DJ. Factors associated with non-attendance in the Irish national diabetic retinopathy screening programme (INDEAR study report no. 2). Acta Diabetol 2021; 58:643-650. [PMID: 33483856 PMCID: PMC8076137 DOI: 10.1007/s00592-021-01671-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023]
Abstract
AIMS We aimed to determine the patient and screening-level factors that are associated with non-attendance in the Irish National Diabetic Retinal screening programme (Diabetic RetinaScreen). To accomplish this, we modelled a selection of predictors derived from the historical screening records of patients with diabetes. METHODS In this cohort study, appointment data from the national diabetic retinopathy screening programme (RetinaScreen) were extracted and augmented using publicly available meteorological and geospatial data. A total of 653,969 appointments from 158,655 patients were included for analysis. Mixed-effects models (univariable and multivariable) were used to estimate the influence of several variables on non-attendance to screening appointments. RESULTS All variables considered for analysis were statistically significant. Variables of note, with meaningful effect, were age (OR: 1.23 per decade away from 70; 95% CI: [1.22-1.24]), type 2 diabetes (OR: 1.10; 95% CI: [1.06-1.14]) and socio-economic deprivation (OR: 1.12; 95% CI: [1.09-1.16]). A majority (52%) of missed appointments were from patients who had missed three or more appointments. CONCLUSIONS This study is the first to outline factors that are associated with non-attendance within the Irish national diabetic retinopathy screening service. In particular, when corrected for age and other factors, patients with type 2 diabetes had higher rates of non-attendance. Additionally, this is the first study of any diabetic screening programme to demonstrate that weather may influence attendance. This research provides unique insight to guide the implementation of an optimal and cost-effective intervention strategy to improve attendance.
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Affiliation(s)
- Stephen R Kelly
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Allison R Loiselle
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, Netherlands
| | - Rajiv Pandey
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Colette Murphy
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Helen Kavanagh
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
| | - Patricia Kearney
- Department of Epidemiology, University College Cork, Cork, Ireland
| | - David P Crabb
- Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David J Keegan
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
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