Page 148 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 8
ABSTRACT
BACKGROUND The EUSCREEN study compares paediatric vision and hearing screening programmes with a cost-effectiveness model. Alongside the development of the model, vision screening was implemented the county of Cluj, Romania in 2018 and 2019. We report on the first year.
METHODS Implementation plans were drafted, defining objectives, target population, screening protocol, vision charts, training, care pathways and follow-up. In cities, children were screened by kindergarten nurses. In rural areas, kindergartens have no nurses and children were screened by family doctors’ nurses, initially at the doctors’ offices and later also at kindergartens. All screeners attended a CME-accredited two- day course. Implementation was assessed through on-site observations, interviews, questionnaires and analysis of screening results.
RESULTS Out of 233 participants in the screening courses, 97 (42%) screened children. Participation of rural nurses was low. Out of 12,795 eligible four- and five- year-old children, 7,876 were screened: in Cluj-Napoca 1.62x the average annual birth rate, in small cities 1.64x and in rural areas 0.49x. In 51 out of 75 rural communes, no screening took place at all. Rural areas have less than half the number of family doctors as compared to urban areas and their nurses therefore often lacked the time to participate. Parents did not bring their children to be screened. Rural kindergartens have no resident nurses and few children. Of all children screened, 1,071 (14%) were referred but ophthalmologists’ diagnostic assessments were received for only 200 (19%). Four screeners examined 86 or more children without referring a single child (while the prevalence of amblyopia is about 3%).
CONCLUSIONS In the cities, children were successfully screened by resident nurses. In rural areas screening was hampered by a lack of healthcare infrastructure and personnel, competing preventive healthcare priorities, travel distances, lack of easy access to many children and lack of awareness among parents.
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