Page 153 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Implementing paediatric vision screening in urban and rural areas in Cluj county, Romania
Referral
Once low visual acuity had been detected, amblyopia, or another ophthalmological condition, needed to be diagnosed and treated. All ophthalmologists in Cluj County were sent a letter by the UMF-Cluj about the implementation of vision screening. They were asked whether they were willing to examine and treat children who had screened positively. Ophthalmologists who responded affirmatively, were included in the list given to parents when their child was referred. Diagnostic assessment by orthoptists was not an option because there are no orthoptists in Romania. While the Romanian health insurance covers a visit to an ophthalmologist, it does not cover occlusion patches or glasses17 and treatment was not funded by the study. On average, amblyopia treatment requires two pairs of glasses and around 500 patches, roughly estimated. Glasses cost, depending on specifications, about RON 500,- (€105,- ) on average, but are available from around RON 140,- (€29,-). A patch costs about RON 2.45 (€0.51). The price of glasses and patches could be high for low-income parents, considering the average monthly net salary in Cluj County in 2017 was RON 2,668,- (€558,-).11
Implementation assessment
The implementation was assessed using a framework based on the work of Peters et al.18 and Proctor et al.19 The implementation outcomes that were assessed and the measurement method are displayed in table 1.
Four visits were made to Romania for on-site interviews and observations. The first visit was made while preparations for screening were being made and courses for screeners took place (AH, MF), the second when screening had just started (HJS, MN), the third a few months later (HJS, MN) and the fourth after one year of screening (MF, AH, MN, JK).
Screenings were observed and screening locations throughout the county were visited, where nurses and family doctors were interviewed. When screenings were observed, the explanation and test times were measured with a stopwatch and it was observed if screening was performed according to protocol. During the fourth visit, mostly rural locations were visited, because it had become apparent that implementing screening was more difficult there. Twenty communes were visited and screeners were interviewed, as well as staff at rural kindergartens. Reports were made of the interviews, based on notes taken by multiple authors (MF, AH, MN, JK). These reports were coded and analysed. Additionally, a questionnaire for screeners was developed, based on the questionnaire used by Tjiam et al.,20 to assess the adoption of the protocol by the screeners (Additional file 4).
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