A Community-Based Randomized Interventional Study
Xiu Juan Zhang, MD, PhD,1,* Yuan Bo Liang, MD, PhD,1,* Ying Peng Liu, MD,1,2 Vishal Jhanji, MD,1
David C. Musch, PhD, MPH,3 Yi Peng, MSc, MPH,2 Chong Ren Zheng, MSc, MPH,2 Hui Xi Zhang, MD,4Ping Chen, MD,4 Xin Tang, MD, PhD,5 Dennis S. C. Lam, MD, FRCOphth1,2
Abstract
Purpose: To identify effective methods to increase the number of cataract surgeries in a rural setting in
Pucheng County of Shaanxi Province, northwestern China.
Design: Community-based randomized interventional study.
Participants: Four hundred thirty-two patients 50 years of ageor older with operable cataract who had not undergone surgery 3 months after participation in a cataract outreach screening program.
Methods: Three hundred fifty-five (82.2%) patients eligible for surgery, but not scheduling it on their own,
were contacted and were assigned randomly into 4 groups. Participants in group 1 (n 86) were given informative reminders by telephone or in person by a trained facilitator about undergoing low-cost cataract surgery. Group 2 (n 86) was offered free cataract surgery. Group 3 (n 90) was offered free surgery and reimbursement of transportation expenses. Group 4 (n 93) was provided with free rides from home to hospital in addition to the reminder and free surgery.
Main Outcome Measures: Number of participants undergoing cataract surgery after interventions.
Results: In total, 94 patients (26.5%) underwent cataract surgery after interventions. In group 1, 13 patients (14.4%) underwent surgery, which was significantly lower than the number in group 2 (n 25 [27.8%]; P 0.027), group 3 (n 28 [31.1%]; P 0.012), and group 4 (n 26 [28%]; P 0.038). There were no significant
differences between groups 2 and 3 (P 0.768) or between groups 2 and 4 (P 0.869).
Conclusions: Provision of free cataract surgery was twice as effective as giving patients an informative reminder when it came to increasing the uptake of cataract surgery. However, offering reimbursement of transportation expenses or provision of free rides had minimal added impact on the response rate of participants to undergo cataract surgery.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2013;120:260–265 © 2013 by the American Academy of Ophthalmology.
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| http://www.cehjournal.org/article/increasing-the-volume-of-cataract-surgery-an-experience-in-rural-china/ |
Opinion:
This article is informative, because it is emphasized the importance of free cataract surgery compared to reminder and offering information about low cost cataract surgery in rural China. The reimbursement of travel expenses and free ride for patients give minimal added impact. One point that we must consider while offering cataract surgery is it price compares to individual income in rural area. The people in remote area has lower income so economic side of a surgery is one of the main barrier for people in taking cataract surgery.
Fifteen percent of the participants underwent cataract surgery when they simply were reminded about the availability of low-cost cataract surgery service in or around their residential area. The mean per capita gross domestic product (year 2007) and the annual per capita income in Pucheng County are US$1009/person and US$375, respectively. Therefore, cataract surgery, even at US$38/surgery, is a considerable economic burden for an individual. This likely is the reason for a statistically significant increase in the proportion of participants (29.1%) who underwent cataract surgery when they were offered a free surgical procedure.
In Indonesia, National Health Coverage (BPJS) give an advantage because people can get cataract surgery service for free. So that one of the strategy which is important to be implemented in Indonesia is expand BPJS participation from people in remote are. Moreover, some people in remote area can not participate in BPJS because of a administrative problem. The collaboration with organizations, companies or foundations that can provide grant for free cataract surgery is necessary to back up this problem.
Reference:
http://www.sciencedirect.com/science/article/pii/S0161642012007518
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