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Rooth V, van der Aa H, Wisse RPL, Maarsingh OR, Koopmanschap M, Keunen JEE, Vermeulen H, Klaver CCW, Janssen G, van Rens GHMB, van Nispen RMA. Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial. Trials 2024; 25:102. [PMID: 38308377 PMCID: PMC10835833 DOI: 10.1186/s13063-023-07882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening. METHODS A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up. DISCUSSION An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.
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Affiliation(s)
- Vera Rooth
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - Hilde van der Aa
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Robert P L Wisse
- Department of Ophthalmology, UMC Utrecht, Utrecht, The Netherlands
| | - Otto R Maarsingh
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
- General Practice, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Health Technology Assessment (HTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan E E Keunen
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | | | - Ger H M B van Rens
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
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Elsman EBM, Lee SQ, van der Aa HPA, van Nassau F, Wisse RPL, Maarsingh OR, Keunen JEE, van Rens GHMB, van Nispen RMA. The evaluation of an online nurse-assisted eye-screening tool in older adults receiving home healthcare. Ophthalmic Physiol Opt 2023. [PMID: 36807604 DOI: 10.1111/opo.13110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To investigate the agreement between an online nurse-assisted eye-screening tool and reference tests in older adults receiving home healthcare and to collect user experiences. METHODS Older adults (65+) receiving home healthcare were included. Home healthcare nurses assisted in administering the eye-screening tool at participants' homes. Approximately 2 weeks later, a researcher administered reference tests at participants' homes. Experiences from participants and home healthcare nurses were collected. Agreement in outcomes (distance and near visual acuity, with the latter being measured using two different optotypes, and macular problems) between the eye-screening tool and reference clinical testing was compared. A difference of less than ±0.15 logMAR was considered acceptable. RESULTS A total of 40 participants were included. Here, we describe the results for the right eye; results for the left eye were similar. The mean difference between the eye-screening tool and reference tests for distance visual acuity was 0.02 logMAR. The mean difference between the eye-screening tool and reference tests using two different optotypes for near visual acuity was 0.06 and 0.03 logMAR, respectively. The majority of the individual data points were within the ±0.15 logMAR threshold (75%, 51% and 58%, respectively). The agreement between tests for macular problems was 75%. Participants and home healthcare nurses were generally satisfied with the eye-screening tool, although remarks for further improvements were made. CONCLUSIONS The eye-screening tool is promising for nurse-assisted eye screening in older adults receiving home healthcare, with the mostly satisfactory agreement. After implementing the eye-screening tool in practice, cost-effectiveness needs to be investigated.
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Affiliation(s)
- Ellen B M Elsman
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Shan Qi Lee
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Femke van Nassau
- Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands.,Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Otto R Maarsingh
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Aging & Later Life, Amsterdam Public Health, Amsterdam, the Netherlands
| | | | - Ger H M B van Rens
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Quality of Care, Amsterdam Public Health, Amsterdam, the Netherlands
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Nispen R, Aa H, Timmermans F, Meijer N, Koster N, de Blok J, Keunen J, Rens G. Reducing avoidable visual impairment in elderly home healthcare patients by basic ophthalmologic screening. Acta Ophthalmol 2019; 97:401-408. [PMID: 30369070 PMCID: PMC6587994 DOI: 10.1111/aos.13956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the prevalence of potential age-related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner (GP), feasibility of screening and associations between vision loss and health outcomes were also studied. METHODS Cross-sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50-96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires. RESULTS Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self-reported outcomes. CONCLUSION Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age-related vision loss, contributing to the joint World Health Organization - VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems.
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Affiliation(s)
- Ruth Nispen
- Ophthalmology, Amsterdam Public Health research institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Hilde Aa
- Ophthalmology, Amsterdam Public Health research institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | | | - Nikki Meijer
- Albert Schweitzer hospital Dordrecht The Netherlands
| | - Nicole Koster
- Department of Research Methodology, Measurement and Data Analysis Faculty of Behavioural, Management & Social Sciences University of Twente Enschede The Netherlands
| | - Jos de Blok
- Stichting Buurtzorg Nederland Almelo The Netherlands
| | - Jan Keunen
- Radboud University Medical Center, Ophthalmology Nijmegen The Netherlands
| | - Ger Rens
- Ophthalmology, Amsterdam Public Health research institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Elkerliek Hospital, Ophthalmology Helmond The Netherlands
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