Improve Timely Referral Flow and Compliance of Diabetic Retinopathy Patients

NCT04834648 | Completed DMC

• 1 other identifier: LEI/IRC/09/019/20
• Study Type: interventional
• Target: 150
• Locations: 1 country
• Sites: 1

Brief Summary

An effective referral system helps to ensure a close relationship between all levels of the health system and ensures clients receive optimum care at the appropriate level and at affordable cost, and hospital facilities are used optimally and cost-effectively. A referral system requires consideration of all its important components that can be then adjusted to the local situation. Being a system, the important components of a referral system are Health system issues (Service providers, Referral protocols, Communication \& transportation provide), Referring facility\& Referral practicalities (Client \& their condition, Protocols of care, Care provider \& documents, Referral decision, Outward referral form, Communicate with referral facility, Client information, Referral register), Referral facility\& Referral practicalities (Client with referral form, Treat the client with the document, Rehabilitation plan, Back referral form, Feedback to referring facility, Referral register) and Supervision and capacity building (Referral monitoring, Ensure back referral, Feedback and training to facility staff and Feedback to central level) ((USAID), 2012). There are mainly two limitations on referring Diabetic Retinopathy patients. Patient-related reasons: lack of awareness, belief, cost, distance from screening/ treatment centers, discomfort from dilating drops, efforts to attend yet another center, fear of laser treatment, fear of its impact on quality of life and jobs, lack of family support and guilt surrounding the failure to control blood sugar. Provider-related reasons are poor counseling and advisory services about ocular complications for patients with diabetes, inefficient call and recall system, long waiting times for screening or treatment, and complicated referral mechanism. Lumbini eye institute is a comprehensive tertiary eye care center in western Nepal. In spite of 19 peripheral referral centers under it, there is a poor inflow of Diabetic retinopathy patients as against the estimated disease burden in the catchment area. The objective of our study is to improve timely referral flow from referring centers and compliance with referral cases after the intervention. In order to meet our objective, the investigators tend to implement patient counseling at referral centers, a referral tracking system, and a fast-track mechanism for patients at base hospitals.

Conditions

Diabetes; Diabetic Retinopathy

Keywords

referral rate; diabetic retinopathy; counselling

Outcome Measures

Primary Outcomes (1)

• Primary Outcome

  Percentage of referral compliance before and after intervention

  8 months

Study Arms (2)

Structured Counseling

EXPERIMENTAL

Structured Counseling, which includes A. Counseling is done by a trained counselor B. Telephonic Follow up: C. Development of Fast Track system at the Base Hospital. D. Provide Health Education Material to all Diabetic Patients. E. Referral communication and feedback between referring and referral facility.

Behavioral: Structured Counseling

Control Arm

NO INTERVENTION

General Counseling, which included saying you need to visit the hospital and you have involvement in the eyes due to diabetes, providing a health education leaflet.

Interventions

Structured Counseling BEHAVIORAL

Structured Counseling, which includes A. Counseling is done by a trained counselor B. Telephonic Follow up: C. Development of Fast Track system at the Base Hospital. D. Provide Health Education Material to all Diabetic Patients. E. Referral communication and feedback between referring and referral facility.

Structured Counseling

Eligibility Criteria

• Age: 16 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All Diabetic Retinopathy patients attending the peripheral eye centers linked with LEIRC.

You may not qualify if:

• All referred Diabetic patients who not is willing to be part of the study.

Sponsors & Collaborators

• Seva Foundation: lead
• Lumbini Eye Institute and Research Centre: collaborator
• Indian Institute of Public Health, India: collaborator
• Seva Canada Society: collaborator
• Queen's University, Belfast: collaborator

Study Sites (1)

Lumbini Eye Institute and Research Center

Butwāl, Nepal

Location

Related Publications (1)

• Bhattarai B, Thapa HB, Bashyal S, Thapa SK, Chaudhuri S, Agiwal V, Pant H, Singh S, Mahajan H. Structured Counselling and Regular Telephonic follow up to improve Referral flow and compliance in Nepal for Diabetic Retinopathy(SCREEN-D Study): a randomised controlled trial. BMC Health Serv Res. 2024 Feb 10;24(1):188. doi: 10.1186/s12913-024-10647-3.

  PMID: 38336691 DERIVED

MeSH Terms

Conditions

Diabetes Mellitus; Diabetic Retinopathy

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Retinal Diseases; Eye Diseases; Diabetic Angiopathies; Vascular Diseases; Cardiovascular Diseases; Diabetes Complications

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: CARE PROVIDER
• Masking Details: At LEI the staff will be blinded about the intervention/ control referring centers
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 4, 2021
• First Posted: April 8, 2021
• Study Start: March 15, 2021
• Primary Completion: August 30, 2021
• Study Completion: December 30, 2021
• Last Updated: March 10, 2022

Record last verified: 2022-03

Data Sharing

• IPD Sharing: Will not share

Locations

NE (1)