Importance of and strategies to follow up pediatric

Importance of and strategies to follow up pediatric ophthalmology patients Preethi Pradhan Sr Faculty, LAICO Aravind Eye Care System A 2 Z Child Blindness Program Regional Capacity Building Workshop April 29 -30, 2011

4 stages of sight restoration Accepts Doctors advice 1. Early detection 2. Eye examination 3. Good quality treatment 4. Follow-up care Quality eye care Regular follow up Visits the hospital for a check up Courtesy: Dr Muhit Childhood Cataract: Home to Hospital, CEH Vol 17, No 50, 2004

Why follow up is important? For Patient For Doctor � Patients are dependent on � Outcome of the surgery or caregivers to take them to the hospital for check up � Serves to surface any other concern as children do not complain of worsening vision � They can meet the same doctor who carried out the intervention whether it is good they can assess � Can help to schedule their work better � Can provide better patient satisfaction Giving a specific follow up date helps the patient to remember when to come back

Follow up Rate Follow Up Rate = No of patients who came for follow up Total no of patients who were asked to come for follow up A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

First: You need to measure the Follow up Rate To screen children in private schools and provide them cards – Total no. of schools screened 8 Total no. of students screened 16982 Total no. of students with defective vision 1269 (7. 5%) Total no. students who came for check up at the hospital on Sunday 460 (36%) If you are not measuring you wont know and you can’t improve

Scenario 1: You receive this report - what do you do? 1 05 -01 -2007 R. M. Surgery Follow up 92% 2 06 -01 -2007 TC. S. 85% 3 07 -01 -2007 S M. L. 98% 4 19 -01 -2007 M. S. 82% 5 20 -01 -2007 UP. R. 63% 6 21 -01 -2007 VM. K. 57% 7 21 -01 -2007 N. 96% 8 21 -01 -2007 DU. G. 98% 9 21 -01 -2007 R. S. 90% 10 21 -01 -2007 S. R. 95% 11 21 -01 -2007 C K. V. 93% 12 23 -01 -2007 MS. B. 71% S. No. Date Counselor A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Two weeks after cataract surgery at home, one morning the father notices his child’s eye is reddish. What should I do now? Should I go back to the eye hospital or can I consult local ophthalmologist? A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

My son’s follow-up check up is on the same date as my sister’s wedding Will the doctor be available then? When date should I go? A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011 Wou ld it possi ble fo be r chan ge th me to e dat e?

Reasons for irregular follow up School studies School Examinations Improper follow up of instructions Child falls ill Poor communication A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Strategies for Overcoming these Barriers Counseling Training of Trainers Workshop April 15 -17, 2011

Strategies to address issues related to School Studies Follow up card addressed to teachers A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Strategies to address issues related to School Examinations �Consult with parents before giving follow up date �Double check if they will be able to come on that date A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Strategies to address issues related when child falls ill Remind parents about the importance of the follow up Reschedule the appointment A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Strategies to address issues related to lack of following instructions Encourage them to come any way Reinforce importance of compliance and the consequence of not following up A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Strategies to address issues related to Poor Communication � Lack of communication between the child’s parents and their relatives � Identify the key decision maker � Are we addressing communication to all? � Need to communicate whether outcome of surgery is good or bad need to come for follow up � Provide instruction in a print or written format A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Review patients waiting time to be reduced �Review patients are seen by senior Medical officer and disposed as early as possible. �Separate vision room for > 5 years & < 5 years - A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

Tips to ensure follow up �Ensure convenient date & time for the parents and the child � Avoid exam dates, festivals, inauspicious days etc �Provide printed instructions � Follow up cards � Appointment cards �Reminders � Text message � Phone calls � Postcards A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011

2010 Data on Follow up Jan Feb Mar April may june July Aug Sep oct same Appointment date 70 53 67 117 96 73 82 71 70 57 Post surgical follow up other date Same date% Total Nov 72 48 17 65 Dec 52 31 10 41 54 81 81 72 63 52 85 79 84 72 67 60 880 622 169 791 71 Total 38 43 54 84 60 38 70 56 59 41 20 6 8 22 22 30 8 8 6 12 58 49 62 106 82 68 78 64 65 53 Total % A to Z Child Blindness Program Regional Capacity Building Workshop April 29 – 30, 2011 83 92 93 91 85 93 95 90 93 93 90 79 90

Thank You !!! A 2 Z Child Blindness Program Regional Capacity Building Workshop April 29 -30, 2011