Analysis of referral adherence and associated factors in children and adolescents screened with abnormal refractive error in Huangpu District, Shanghai

Abstract

Objective To understand the referral rate in children with abnormal refractive error in screening programs and associated factors, aiming to provide evidence for improving the rate and myopia prevention and control in the future.

Methods Using cluster sampling, three primary schools and three junior middle schools in Huangpu District, Shanghai were selected. All students were archived for refractive development, including examinations such as visual acuity, non-cycloplegic autorefraction and axial length. The follow-up visit and related factor information were collected through questionnaire, and the influencing factors of referral rate were analyzed by multivariate Logistic regression.

Results A total of 2 104 high-risk children and adolescents with suspected refractive abnormalities were suggested follow-up visit, and the actual referral rate was estimated to be 60.4%; the rate of referral to designated hospitals was estimated to be 58.8%. Non-conditional Logistic regression analysis showed that myopic status before the screening ( OR = 1.37, 95% CI = 1.08–1.72), wearing spectacles or ortho contact lens ( OR = 2.05, 95% CI = 1.62–2.59), myopic degree ( OR _{below −0.5 D} = 2.08, 95% CI = 1.48–2.92, OR _{−3.0~−0.5 D} = 1.86, 95% CI = 1.47–2.36), parents’ familiarity with screening results ( OR = 2.92, 95% CI = 1.89–4.50), parents’ satisfaction with suggestions after screening ( OR = 3.54, 95% CI = 1.16–10.79) were significant factors associated with the referral rate ( P<0.05).

Conclusion The actual referral rate among children and adolescents needs to be improved. It is necessary to further optimize the informatization of refractive archives, strengthen popular science education for key population, standardize the professional interpretation of preliminary screening refractive examination results, improve parents’ awareness, participation and satisfaction through health education, and achieve the whole process management of refractive archives.

Abstract

【摘要】 目的 了解屈光筛査异常儿童青少年复诊率和复诊依从性相关影响因素, 为加强儿童青少年屈光发育档案管理 与应用、提升近视防控效率和效果提供依据。 方法 采用整群抽样的方法, 选取上海市黄浦区3所小学和3所初中学校开 展调査, 对所有学生建立屈光发育档案, 包括视力、非睫状肌麻痹电脑验光和眼轴长度等眼科检査, 并通过问卷调査收集复 诊及相关因素信息, 采用多因素Logistic回归分析复诊的相关因素。 结果 筛査出疑似屈光异常的儿童青少年共 2 104 名, 通知需复诊儿童青少年实际复诊率 60.4%, 其中指定定点医院复诊占 58.8%。筛査前已有近视 ( OR = 1.37, 95% CI = 1.08~1.72)、筛査前已佩戴框架眼镜或角膜塑形镜 ( OR = 2.05, 95% CI = 1.62~2.59)、初筛后近视度数 ( OR _{−0.5 D似下} = 2.08, 95% CI = 1.48~2.92, OR _{−3.0~−0.5 D} = 1.86, 95% CI = 1.47~2.36)、初筛结果家长知晓 ( OR = 2.92, 95% CI = 1.89~4.50)、对复诊建 议满意 ( OR = 3.54, 95% CI = 1.16~10.79) 等 5 个因素为屈光筛査异常儿童青少年复诊依从性的影响因素 ( P 值均<0.05)。 结论 屈光筛査异常需复诊儿童青少年实际复诊率有待提髙。需进一步优化屈光档案医防融合信息化, 针对重点人群加 强科普宣教、规范初筛屈光检査结果的专业解读, 并通过健康宣教提升家长知晓度、参与度和满意度, 实现屈光档案分级分 类全流程闭环管理。