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      Improving the Follow-up Rate for Pediatric Patients (0-16 years) of an Eye Hospital in Nepal: Protocol for a Public Health Intervention Study

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          Abstract

          Background

          The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates.

          Objective

          This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients.

          Methods

          This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted.

          Results

          The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size).

          Conclusions

          This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital.

          Trial Registration

          ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534

          International Registered Report Identifier (IRRID)

          DERR1-10.2196/31578

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          Most cited references17

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          Epidemiology of blindness in children

          Ameenat Lola Solebo, Lucinda Teoh, Jugnoo Rahi (2017)
          An estimated 14 million of the world's children are blind. A blind child is more likely to live in socioeconomic deprivation, to be more frequently hospitalised during childhood and to die in childhood than a child not living with blindness. This update of a previous review on childhood visual impairment focuses on emerging therapies for children with severe visual disability (severe visual impairment and blindness or SVI/BL).For children in higher income countries, cerebral visual impairment and optic nerve anomalies remain the most common causes of SVI/BL, while retinopathy of prematurity (ROP) and cataract are now the most common avoidable causes. The constellation of causes of childhood blindness in lower income settings is shifting from infective and nutritional corneal opacities and congenital anomalies to more resemble the patterns seen in higher income settings. Improvements in maternal and neonatal health and investment in and maintenance of national ophthalmic care infrastructure are the key to reducing the burden of avoidable blindness. New therapeutic targets are emerging for childhood visual disorders, although the safety and efficacy of novel therapies for diseases such as ROP or retinal dystrophies are not yet clear. Population-based epidemiological research, particularly on cerebral visual impairment and optic nerve hypoplasia, is needed in order to improve understanding of risk factors and to inform and support the development of novel therapies for disorders currently considered 'untreatable'.
          Article 0 comments Cited 110 times – based on 0 reviews     Review now
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            Effectiveness of mobile-phone short message service (SMS) reminders for ophthalmology outpatient appointments: Observational study

            Elizabeth Koshy, Josip Car, Azeem Majeed (2008)
            Background Non-attendance for hospital outpatient appointments is a significant problem in many countries. It causes suboptimal use of clinical and administrative staff and financial losses, as well as longer waiting times. The use of Short Message Service (SMS) appointment reminders potentially offers a cost-effective and time-efficient strategy to decrease non-attendance and so improve the efficiency of outpatient healthcare delivery. Methods An SMS text message was sent to patients with scheduled appointments between April and September 2006 in a hospital ophthalmology department in London, reminding them of their appointments. This group acted as the intervention group. Controls were patients with scheduled ophthalmology appointments who did not receive an SMS or any alternative reminder. Results During the period of the study, 11.2% (50/447) of patients who received an SMS appointment reminder were non-attenders, compared to 18.1% (1720/9512) who did not receive an SMS reminder. Non-attendance rates were 38% lower in patients who received an SMS reminder than in patients who did not receive a reminder (RR of non-attendance = 0.62; 95% CI = 0.48 – 0.80). Conclusion The use of SMS reminders for ophthalmology outpatient appointments was associated with a reduction of 38% in the likelihood of patients not attending their appointments, compared to no appointment reminder. The use of SMS reminders may also be more cost-effective than traditional appointment reminders and require less labour. These findings should be confirmed with a more rigorous study design before a wider roll-out.
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              Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

              Surajudeen Abdulrahman, Lekhraj Rampal, Faisal Ibrahim … (2017)
              Background Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART). Objective(s) Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. Methods A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention. Results The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39–96.97) as compared to the control group (87.5; 95% CI: 86.14–88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group. Conclusion Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.
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                Author and article information

                Contributors
                Manisha Shrestha:
                ORCID: https://orcid.org/0000-0002-2498-5401
                Bharatpur Eye HospitalBypass Rd-10Bharatpur Metropolitan CityChitwan, 42201Nepal977 984 502 3273maneeshasht9845@gmail.com
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: October 2021
                Publication date (Electronic): 8 October 2021
                Volume: 10
                Issue: 10
                Electronic Location Identifier: e31578
                Affiliations
                [1 ] Bharatpur Eye Hospital Chitwan Nepal
                [2 ] Indian Institute of Public Health Hyderabad India
                [3 ] See Authors' Contributions
                Author notes
                Corresponding Author: Manisha Shrestha maneeshasht9845@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-2498-5401
                https://orcid.org/0000-0001-9452-8874
                https://orcid.org/0000-0002-8480-1627
                https://orcid.org/0000-0001-7339-5320
                https://orcid.org/0000-0002-3593-0588
                https://orcid.org/0000-0001-6840-4659
                https://orcid.org/0000-0002-1107-0018
                https://orcid.org/0000-0003-2804-1026
                https://orcid.org/0000-0002-4205-8580
                https://orcid.org/0000-0003-3486-1768
                Article
                Publisher ID: v10i10e31578
                DOI: 10.2196/31578
                PMC ID: 8538025
                PubMed ID: 34521615
                SO-VID: 71865ec6-f679-40b5-8b81-c82b152699db
                Copyright © ©Manisha Shrestha, Gopal Bhandari, Suresh Kumar Rathi, Anirudh Gaurang Gudlavalleti, Binod Pandey, Ramesh Ghimire, Daman Ale, Sajani Kayastha, Daya Shankar Chaudhary, Raghunandan Byanju, Operational Research Capacity Building Study Group. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.10.2021.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 26 June 2021
                Date revision requested : 22 July 2021
                Date revision received : 24 August 2021
                Date accepted : 13 September 2021
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: counseling,follow-up,intervention study,pediatric patients,ophthalmology,public health,nepal
                Data availability:
                Keywords: counseling, follow-up, intervention study, pediatric patients, ophthalmology, public health, nepal

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