Hillary Rono1, Andrew Bastawrous2, David Macleod3, Ronald Mamboleo4, Cosmas Bunywera5, Emmanuel Wanjala4, Stephen Gichuhi6, Matthew J Burton7. 1. International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kitale County Referral and Teaching Hospital, Kitale, Kenya; Peek Vision, Berkhamsted, Hertfordshire, UK. Electronic address: hillary.rono@lshtm.ac.uk. 2. International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, Berkhamsted, Hertfordshire, UK. 3. MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK. 4. Kitale County Referral and Teaching Hospital, Kitale, Kenya. 5. Peek Vision, Berkhamsted, Hertfordshire, UK. 6. Department of Ophthalmology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya. 7. International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital NHS Trust, London, UK.
Abstract
BACKGROUND: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting. METHODS: In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632. FINDINGS:Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228-1629) in the intervention group and 522 (418-625) in the control group (rate difference 906 per 10 000 [95% CI 689-1124; p<0·0001]). INTERPRETATION: The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing. FUNDING: The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.
RCT Entities:
BACKGROUND: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting. METHODS: In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632. FINDINGS: Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228-1629) in the intervention group and 522 (418-625) in the control group (rate difference 906 per 10 000 [95% CI 689-1124; p<0·0001]). INTERPRETATION: The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing. FUNDING: The Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.
Authors: Tiarnan D L Keenan; Qingyu Chen; Elvira Agrón; Yih-Chung Tham; Jocelyn Hui Lin Goh; Xiaofeng Lei; Yi Pin Ng; Yong Liu; Xinxing Xu; Ching-Yu Cheng; Mukharram M Bikbov; Jost B Jonas; Sanjeeb Bhandari; Geoffrey K Broadhead; Marcus H Colyer; Jonathan Corsini; Chantal Cousineau-Krieger; William Gensheimer; David Grasic; Tania Lamba; M Teresa Magone; Michele Maiberger; Arnold Oshinsky; Boonkit Purt; Soo Y Shin; Alisa T Thavikulwat; Zhiyong Lu; Emily Y Chew Journal: Ophthalmology Date: 2022-01-03 Impact factor: 14.277
Authors: Mark P Khurana; Daniel E Raaschou-Pedersen; Jørgen Kurtzhals; Jakob E Bardram; Sisse R Ostrowski; Johan S Bundgaard Journal: BMC Med Educ Date: 2022-02-26 Impact factor: 2.463
Authors: Luke N Allen; Bakgaki Ratshaa; David Macleod; Nigel Bolster; Matthew Burton; Min Kim; Andrew Bastawrous; Ari Ho-Foster; Hannah Chroston; Oathokwa Nkomazana Journal: Trials Date: 2022-08-15 Impact factor: 2.728