Improving the Follow up Rate for Pediatric Patients

Summary

Follow-up of pediatric patients is important for their regular ocular morbidity monitoring, especially for amblyopia management. An observatory data of 1st week (1st to 7th) of January 2019 revealed that the follow-up compliance was very low (22%) among children aged 0-16 years in the pediatric department of Bharatpur Eye Hospital. A problem tree analysis showed a lack of awareness in children and their parents regarding the importance of follow-up and patients forgetting regarding the follow-up visit, usually when there is the long duration of follow up are the major contributing factors for poor adherence to follow-up. So, an intervention study was aimed at finding the effectiveness of counseling and reminders through SMS and phone calls to improve the follow-ups.

All pediatric patients 0-16 years of age with ocular conditions requiring at least 3 follow-ups in the study period (January 2021 to April 2021) will be included. Two hundred and sixty-four participants will be equally distributed to three groups: routine standard care, counseling, and reminders with SMS and phone calls. In the routine care group, children will undergo routine care as per existing practice in the hospital and there will be no additional intervention. In counseling group, in addition to routine care parents/guardians along with the child will receive counseling from a trained counselor as per the set counseling protocol in every follow-up visits and will also be provided with the disease-specific information leaflets as additional information material before the child is discharged from the department. In the SMS and phone call reminder group, in addition to routine care, parents/guardians of children will receive reminders through short messaging text (SMS) 3 days and phone calls one day prior to the scheduled visit.

Compliance to follow up Participants completing all the three follow-up visits as per the schedule within the window period of +/-2 days will be considered as a complaint to follow up. However, the follow-ups of all the participants will be recorded although that is beyond the window period. The primary outcome will be measured by the proportion of children completing all three scheduled follow-ups.

The ethical approval has been obtained from the Institutional Review Committee of NHRC (ERB protocol registration number 761/2020 P). Informed consent will be taken from parent and child.

Conclusion:

If interventions improve the follow-up rate and are cost-effective, this can be applied in all the departments of the hospital.

Conditions

• CNLDO - Congenital Nasolacrimal Duct Obstruction
• Amblyopia
• Conjunctivitis
• Eye Injuries
• Corneal Ulcer
• Strabismus

Interventions

BEHAVIORAL

Counseling group

In this group after the children have been examined, treatment plan and follow up schedule been advised by a pediatric ophthalmologist, parents/guardians along with the child will receive counseling from a trained counselor as per the set counseling protocol in every follow-up visits and will also be provided with the disease-specific information leaflets as an additional information material before the child is discharged from the department.

BEHAVIORAL

SMS and phone call reminder group

In this group after the children have been examined, treatment plan, and the follow-up schedule been advised, they will be discharged from the department but later they will receive reminders through short messaging text (SMS) and phone calls as per the set protocol.

Sponsors & Collaborators

• Bharatpur Eye Hospital

  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

Principal Investigators

• Dr Manisha Shrestha · Bharathpur Eye Hospital

Study Design

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

1 Day

Max Age

16 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-02-15

Primary Completion

2021-10-30

Completion

2021-12-30

Countries

• Nepal

Study Locations