Task sharing: situation analysis about capacity and resources for management of diabetic retinopathy in Pakistan
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摘要
AIM: To assess the capacity and resources of eye care facilities, using the WHO Health Systems Framework, to manage diabetic retinopathy(DR) through task sharing.METHODS: Using purposive sampling, four participants(administrators) from four selected hospitals in two provinces in Pakistan were recruited for this cross-sectional study. A survey, to assess the capacity and resources of the selected eye care facilities for the feasibility to adopt task sharing in management of DR to prevent vision loss, was emailed to participants who were asked to complete. Responses to open-ended questions were entered into a Microsoft Excel spread sheet and inductive approach was applied for analysis.RESULTS: All the surveyed eye care facilities offer eye care services for people with diabetes and DR. All surveyed eye care facilities have a shortage in the number of human resources across all cadres. Optometrists and mid-level eye care workers did not have active roles in DR screening and management in all four hospitals. All the hospitals surveyed did not have a computerized record management system for patients who visit ophthalmologists for eye examinations. Equipment for detection and management of DR were short in number and main users were ophthalmologists. There was no policy for population-based screening program for detection of DR in any of the surveyed hospitals.CONCLUSION: A system-based approach to manage DR is needed. The capacity of eye care facilities and the potential to improve access of people with diabetes to eyecare services can be enhanced through implementation of task sharing.
AIM: To assess the capacity and resources of eye care facilities, using the WHO Health Systems Framework, to manage diabetic retinopathy(DR) through task sharing.METHODS: Using purposive sampling, four participants(administrators) from four selected hospitals in two provinces in Pakistan were recruited for this cross-sectional study. A survey, to assess the capacity and resources of the selected eye care facilities for the feasibility to adopt task sharing in management of DR to prevent vision loss, was emailed to participants who were asked to complete. Responses to open-ended questions were entered into a Microsoft Excel spread sheet and inductive approach was applied for analysis.RESULTS: All the surveyed eye care facilities offer eye care services for people with diabetes and DR. All surveyed eye care facilities have a shortage in the number of human resources across all cadres. Optometrists and mid-level eye care workers did not have active roles in DR screening and management in all four hospitals. All the hospitals surveyed did not have a computerized record management system for patients who visit ophthalmologists for eye examinations. Equipment for detection and management of DR were short in number and main users were ophthalmologists. There was no policy for population-based screening program for detection of DR in any of the surveyed hospitals.CONCLUSION: A system-based approach to manage DR is needed. The capacity of eye care facilities and the potential to improve access of people with diabetes to eyecare services can be enhanced through implementation of task sharing.
AIM: To assess the capacity and resources of eye care facilities, using the WHO Health Systems Framework, to manage diabetic retinopathy(DR) through task sharing.METHODS: Using purposive sampling, four participants(administrators) from four selected hospitals in two provinces in Pakistan were recruited for this cross-sectional study. A survey, to assess the capacity and resources of the selected eye care facilities for the feasibility to adopt task sharing in management of DR to prevent vision loss, was emailed to participants who were asked to complete. Responses to open-ended questions were entered into a Microsoft Excel spread sheet and inductive approach was applied for analysis.RESULTS: All the surveyed eye care facilities offer eye care services for people with diabetes and DR. All surveyed eye care facilities have a shortage in the number of human resources across all cadres. Optometrists and mid-level eye care workers did not have active roles in DR screening and management in all four hospitals. All the hospitals surveyed did not have a computerized record management system for patients who visit ophthalmologists for eye examinations. Equipment for detection and management of DR were short in number and main users were ophthalmologists. There was no policy for population-based screening program for detection of DR in any of the surveyed hospitals.CONCLUSION: A system-based approach to manage DR is needed. The capacity of eye care facilities and the potential to improve access of people with diabetes to eyecare services can be enhanced through implementation of task sharing.
引文
1 Burgess PI,MacCormick IJ,Harding SP,Bastawrous A,Beare NA,Garner P.Epidemiology of diabetic retinopathy and maculopathy in Africa:a systematic review.Diabet Med 2013;30(4):399-412.
2 Sohail M.Prevalence of diabetic retinopathy among type-2diabetes patients in Pakistan-vision registry.Pak J Ophthalmol 2014;30(4):204-212.
3 Murthy G.The emerging epidemic of diabetic retinopathy in India:report of a situational analysis and evaluation of existing programmes for screening and treatment of diabetic retinopathy.IAPB report 2015.Available at:https://www.iapb.org/.../the-emerging-epidemic-of-diabeticretinopathy-in-india/.
4 Palmer JJ,Chinanayi F,Gilbert A,Pillay D,Fox S,Jaggernath J,Naidoo K,Graham R,Patel D,Blanchet K.Mapping human resources for eye health in 21 countries of sub-Saharan Africa:current progress towards VISION 2020.Hum Resour Health 2014;12:44.
5 Resnikoff S,Felch W,Gauthier TM,Spivey B.The number of ophthalmologists in practice and training worldwide:a growing gap despite more than 200,000 practitioners.Br J Ophthalmol 2012;96(6):783-787.
6 Shah M,Noor A,Ormsby GM,Chakrabarti R,Harper CA,Islam FA,Keeffe J.Attitudes and perceptions of eye care workers and health administrators regarding task sharing in screening and detection for management of diabetic retinopathy in Pakistan.Ophthalmic Epidemiol2018;25(2):169-175.
7 Hugh SM,Buckley C,Murphy K,et al.Quality-assured screening for diabetic retinopathy delivered in primary care in Ireland:an observational study.Br J Gen Pract 2013;63(607):e134-e140.
8 O’Connor PM,Harper CA,Brunton CL,Clews SJ,Haymes SA,Keeffe JE.Shared care for chronic eye diseases:perspectives of ophthalmologists,optometrists and patients.Med J Aust 2012;196(10):646-650.
9 Rachapelle S,Legood R,Alavi Y,Lindfield R,Sharma T,Kuper H,Polack S.The cost-utility of telemedicine to screen for diabetic retinopathy in India.Ophthalmology 2013;120(3):566-573.
10 Tapp RJ,Svoboda J,Fredericks B,Jackson AJ,Taylor HR.Retinal photography screening programs to prevent vision loss from diabetic retinopathy in rural and urban Australia:a review.Ophthalmic Epidemiol2015;22(1):52-59.
11 Shah M,Ormsby GM,Noor A,Chakrabarti R,M?rchen M,Islam FMA,Harper CA,Keeffe JE.Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia.Int JOphthalmol 2018;11(1):101-107.
12 World Health Organization.Monitoring the building blocks of health systems:a handbook of indicators and their measurement strategies;2010.
13 Shah M,Noor A,Deverell L,Ormsby GM,Harper CA,Keeffe JE.Task sharing in the eye care workforce:Screening,detection,and management of diabetic retinopathy in Pakistan.A case study.Int J Health Plann Mgmt 2018:1-10.
14 Jones S,Edwards RT.Diabetic retinopathy screening:a systematic review of the economic evidence.Diabet Med 2010;27(3):249-256.
15 Rao GN,Khanna RC,Athota SM,Rajshekar V,Rani PK.Integrated model of primary and secondary eye care for underserved rural areas:the L V Prasad Eye Institute experience.Indian J Ophthalmol 2012;60(5):396-400.
16 Aravind Eye Care.Available at:http://aravindeyefoundation.org/home/aefnews/may2011.
17 Backman G,Hunt P,Khosla R,et al.Health systems and the right to health:an assessment of 194 countries.Lancet 2008;372(9655):2047-2085.
18 Blanchet K,Lindfield R.Health Systems and eye care:A way forward.IAPB Briefing Papers London:International Agency for the Prevention of Blindness 2010.
19 Rao GN.The Barrie Jones Lecture-Eye care for the neglected population:challenges and solutions.Eye(Lond)2015;29(1):30-45.
20 Burnett S,Hurwitz B,Davey C,Ray J,Chaturvedi N,Salzmann J,Yudkin JS.The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London:a quality of care study.Diabet Med 1998;15(Suppl 3):S38-S43.
21 White A,Goldberg I.Guidelines for the collaborative care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia.Clin Experiment Ophthalmol 2014;42(2):107-117.
22 Bhattacharyya O,Khor S,McGahan A,Dunne D,Daar AS,Singer PA.Innovative health service delivery models in low and middle income countries-what can we learn from the private sector.Health Res Policy Syst 2010;8(1):24.
2 Sohail M.Prevalence of diabetic retinopathy among type-2diabetes patients in Pakistan-vision registry.Pak J Ophthalmol 2014;30(4):204-212.
3 Murthy G.The emerging epidemic of diabetic retinopathy in India:report of a situational analysis and evaluation of existing programmes for screening and treatment of diabetic retinopathy.IAPB report 2015.Available at:https://www.iapb.org/.../the-emerging-epidemic-of-diabeticretinopathy-in-india/.
4 Palmer JJ,Chinanayi F,Gilbert A,Pillay D,Fox S,Jaggernath J,Naidoo K,Graham R,Patel D,Blanchet K.Mapping human resources for eye health in 21 countries of sub-Saharan Africa:current progress towards VISION 2020.Hum Resour Health 2014;12:44.
5 Resnikoff S,Felch W,Gauthier TM,Spivey B.The number of ophthalmologists in practice and training worldwide:a growing gap despite more than 200,000 practitioners.Br J Ophthalmol 2012;96(6):783-787.
6 Shah M,Noor A,Ormsby GM,Chakrabarti R,Harper CA,Islam FA,Keeffe J.Attitudes and perceptions of eye care workers and health administrators regarding task sharing in screening and detection for management of diabetic retinopathy in Pakistan.Ophthalmic Epidemiol2018;25(2):169-175.
7 Hugh SM,Buckley C,Murphy K,et al.Quality-assured screening for diabetic retinopathy delivered in primary care in Ireland:an observational study.Br J Gen Pract 2013;63(607):e134-e140.
8 O’Connor PM,Harper CA,Brunton CL,Clews SJ,Haymes SA,Keeffe JE.Shared care for chronic eye diseases:perspectives of ophthalmologists,optometrists and patients.Med J Aust 2012;196(10):646-650.
9 Rachapelle S,Legood R,Alavi Y,Lindfield R,Sharma T,Kuper H,Polack S.The cost-utility of telemedicine to screen for diabetic retinopathy in India.Ophthalmology 2013;120(3):566-573.
10 Tapp RJ,Svoboda J,Fredericks B,Jackson AJ,Taylor HR.Retinal photography screening programs to prevent vision loss from diabetic retinopathy in rural and urban Australia:a review.Ophthalmic Epidemiol2015;22(1):52-59.
11 Shah M,Ormsby GM,Noor A,Chakrabarti R,M?rchen M,Islam FMA,Harper CA,Keeffe JE.Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia.Int JOphthalmol 2018;11(1):101-107.
12 World Health Organization.Monitoring the building blocks of health systems:a handbook of indicators and their measurement strategies;2010.
13 Shah M,Noor A,Deverell L,Ormsby GM,Harper CA,Keeffe JE.Task sharing in the eye care workforce:Screening,detection,and management of diabetic retinopathy in Pakistan.A case study.Int J Health Plann Mgmt 2018:1-10.
14 Jones S,Edwards RT.Diabetic retinopathy screening:a systematic review of the economic evidence.Diabet Med 2010;27(3):249-256.
15 Rao GN,Khanna RC,Athota SM,Rajshekar V,Rani PK.Integrated model of primary and secondary eye care for underserved rural areas:the L V Prasad Eye Institute experience.Indian J Ophthalmol 2012;60(5):396-400.
16 Aravind Eye Care.Available at:http://aravindeyefoundation.org/home/aefnews/may2011.
17 Backman G,Hunt P,Khosla R,et al.Health systems and the right to health:an assessment of 194 countries.Lancet 2008;372(9655):2047-2085.
18 Blanchet K,Lindfield R.Health Systems and eye care:A way forward.IAPB Briefing Papers London:International Agency for the Prevention of Blindness 2010.
19 Rao GN.The Barrie Jones Lecture-Eye care for the neglected population:challenges and solutions.Eye(Lond)2015;29(1):30-45.
20 Burnett S,Hurwitz B,Davey C,Ray J,Chaturvedi N,Salzmann J,Yudkin JS.The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London:a quality of care study.Diabet Med 1998;15(Suppl 3):S38-S43.
21 White A,Goldberg I.Guidelines for the collaborative care of glaucoma patients and suspects by ophthalmologists and optometrists in Australia.Clin Experiment Ophthalmol 2014;42(2):107-117.
22 Bhattacharyya O,Khor S,McGahan A,Dunne D,Daar AS,Singer PA.Innovative health service delivery models in low and middle income countries-what can we learn from the private sector.Health Res Policy Syst 2010;8(1):24.