Page 76 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

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are done. We assessed the quality of screening tests by semi-structured observations of CHC physicians screening children aged 1-45 months.
METHODS
This semi-structured observation study is part of the OVAS study.9-10
The Medical Ethical Committee of the Erasmus Medical Center declared that the Medical Research Involving Human Subjects Act did not apply to the OVAS study as it concerned population-based prevention and that the ‘Besluit Publieke Gezondheid’ (Public Health Decision, Ministry of Health 2008) applied, where only permission is required from the health inspector to deviate from the national screening guidelines (reference number MEC-2012-003) and this permission was granted by the health inspector. The research adhered to the tenets of the Declaration of Helsinki.
For this observational study, a form for semi-structured observations was specifically developed to provide a systematic framework to the evaluator’s observation of the screenings tests and to minimize evaluator’s bias. To evaluate the performance of the eye screening tests, observations were performed by two orthoptic students in their fourth and final year of their orthoptic study. During this study, they were coached by a tutor at Utrecht University of Applied Sciences. The two orthoptic students had extensive instructions before the start of the observations from one of the screening instructors, an orthoptist, who trains CHC physicians for eye screening throughout the Netherlands. They attended two one-day eye screening courses of CHC physicians before the start of the observations. The observations took place at the CHC centres of Icare (Public Health Service) in a rural part of the Netherlands in the provinces Drenthe, Gelderland, and Flevoland from February 25th to April 19th, 2013, four days a week. At the start of each consultation permission to attend the consultation was asked of the parents of the participating child. During the consultation, the orthoptic students took notes on the semi-structured observation forms of the performances of all eye screening tests carried out by the CHC physicians, without any involvement in the screening procedure. The children were divided, for analysis, into age categories according to the screening tests (Appendix 1).
The observation form development was based on the Dutch Vision Screening Guideline version 2010,11 the Dutch manual of orthoptic examination techniques,12 studies on quality of examination7-8,13-15 and expert opinion. The observation form contained a general-record section to document the age of the child, his or her health development
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