Improve Timely Referral Flow and Compliance of Diabetic Retinopathy Patients

Summary

An effective referral system helps to ensure a close relationship between all levels of the health system and ensures clients receive optimum care at the appropriate level and at affordable cost, and hospital facilities are used optimally and cost-effectively. A referral system requires consideration of all its important components that can be then adjusted to the local situation. Being a system, the important components of a referral system are Health system issues (Service providers, Referral protocols, Communication \& transportation provide), Referring facility\& Referral practicalities (Client \& their condition, Protocols of care, Care provider \& documents, Referral decision, Outward referral form, Communicate with referral facility, Client information, Referral register), Referral facility\& Referral practicalities (Client with referral form, Treat the client with the document, Rehabilitation plan, Back referral form, Feedback to referring facility, Referral register) and Supervision and capacity building (Referral monitoring, Ensure back referral, Feedback and training to facility staff and Feedback to central level) ((USAID), 2012).

There are mainly two limitations on referring Diabetic Retinopathy patients. Patient-related reasons: lack of awareness, belief, cost, distance from screening/ treatment centers, discomfort from dilating drops, efforts to attend yet another center, fear of laser treatment, fear of its impact on quality of life and jobs, lack of family support and guilt surrounding the failure to control blood sugar. Provider-related reasons are poor counseling and advisory services about ocular complications for patients with diabetes, inefficient call and recall system, long waiting times for screening or treatment, and complicated referral mechanism.

Lumbini eye institute is a comprehensive tertiary eye care center in western Nepal. In spite of 19 peripheral referral centers under it, there is a poor inflow of Diabetic retinopathy patients as against the estimated disease burden in the catchment area. The objective of our study is to improve timely referral flow from referring centers and compliance with referral cases after the intervention. In order to meet our objective, the investigators tend to implement patient counseling at referral centers, a referral tracking system, and a fast-track mechanism for patients at base hospitals.

Conditions

• Diabetes
• Diabetic Retinopathy

Interventions

BEHAVIORAL

Structured Counseling

Structured Counseling, which includes A. Counseling is done by a trained counselor B. Telephonic Follow up: C. Development of Fast Track system at the Base Hospital. D. Provide Health Education Material to all Diabetic Patients. E. Referral communication and feedback between referring and referral facility.

Sponsors & Collaborators

• Lumbini Eye Institute and Research Centre

  collaborator OTHER

• Indian Institute of Public Health, India

  collaborator OTHER

• Seva Canada Society

  collaborator OTHER

• Queen's University, Belfast

  collaborator OTHER

• Seva Foundation

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

16 Years

Max Age

100 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-03-15

Primary Completion

2021-08-30

Completion

2021-12-30

Countries

• Nepal

Study Locations