A novel approach to glaucoma screening and education in Nepal

<p>Abstract</p> <p>Background</p> <p>Glaucoma is a major cause of blindness worldwide and an increasingly significant global health problem. Glaucoma prevention and management efforts have been challenging due to inherent difficulty in developing a simple and cost-effective screening plan, limited access to health care and educational resources, poverty, and inadequate knowledge of the disease, particularly in developing countries. Starting in 2004 the Tilganga Eye Centre in Kathmandu, Nepal has provided targeted glaucoma screening, treatment, and education through a combination of clinical outreach programs and educational activities for patients.</p> <p>Methods</p> <p>A simple, age-based glaucoma screening algorithm was incorporated into three one-day cataract screening clinics. Using this algorithm, patients who were newly diagnosed with glaucoma were referred to TEC, where medication and surgery were provided free of charge through private donor funding. In addition, we describe two ongoing educational programs for increasing glaucoma awareness: an annual Glaucoma Awareness Week (which includes free screening, treatment, and counseling), and a repeating lecture series which generates new counselors.</p> <p>Results</p> <p>From 2004 to 2007 screening at the annual Glaucoma Awareness Week resulted in the diagnosis of 120 individuals with glaucoma, or 7.6% of total registrants. Attendance increased annually with a trend toward an increasing number of returning patients but a decreasing percentage of newly diagnosed patients, though the absolute numbers have remained relatively stable (range 21 to 38). Data from the three one-day screening clinics in 2006 show that approximately 2 to 4% of patients 50 years of age or older per clinic were newly diagnosed with POAG.</p> <p>Conclusion</p> <p>This multi-faceted approach appears to successfully identify individuals with glaucoma and provide treatment to those who would otherwise not be able to afford it. While more data is needed to validate this model, specifically regarding the effectiveness of educational activities, long-term visual outcomes, and medication compliance, it may serve as a useful framework for other developing countries with similarly limited resources.</p

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

<p>Abstract</p> <p>Background</p> <p>We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.</p> <p>The Finnish eye care services system is heterogeneous with several different providers and can be regarded as sub-optimal in terms of overall resource use. What is more, the public sector is suffering from a shortage of ophthalmologists, which further decreases its possibilities to meet the present needs. As ophthalmology has traditionally been a medical specialty with a substantial private sector involvement in service provision, PPP could be a feasible policy to be used in the field. We thus ask the following research question: Is there, and to what extent, an open window of opportunity for PPP?</p> <p>Methods</p> <p>In addition to the previously published literature, the research data consisted of 17 thematic interviews with public and private experts in the field of ophthalmology. The analysis was conducted in two stages. First, a literature-based content analysis was used to explore the prerequisites for PPP. Second, Kingdon's (1995) multiple streams theory was used to study the opening of the window of opportunity for PPP.</p> <p>Results</p> <p>Public and private parties reported similar problems in the current situation but defined them differently. Also, there is no consensus on policy alternatives. Public opinion seems to be somewhat uncertain as to the attitudes towards private service providers. The analysis thus showed that although there are prerequisites for PPP, the time has not yet come for a Public-Private Partnership.</p> <p>Conclusion</p> <p>Should the window open fully, the emergence of policy entrepreneurs and an opportunity for a win-win situation between public and private organizations are required.</p

Developing the specifications of an Open Angle Glaucoma screening intervention in the United Kingdom : a Delphi approach

PMID: 23216983 [PubMed - indexed for MEDLINE] PMCID: PMC3563574 Free PMC Article Acknowledgements We thank all the glaucoma specialists who took part in the Delphi process. We thank the Glaucoma screening Platform Study advisory panel including R Bativala, D Crabb, D Garway-Heath, M Griffiths, R Hitchings; S McPherson, A Tuulonen, A Viswanathan, H Waterman, R Wormald, D Wright for their guidance and contribution to the Delphi process and Luke Vale and Rodolfo Hernandez for their advice on development of the Delphi questionnaires. This paper was developed from the first phase of a project funded by the MRC (project reference G0701759) Developing the intervention & outcome components of a proposed randomized controlled trial of screening for open angle glaucoma. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health Directorates. The views expressed in this report are those of the authors and not necessarily those of the funders.Peer reviewedPublisher PD

Developing the clinical components of a complex intervention for a glaucoma screening trial:a mixed methods study

Peer reviewedPublisher PD