Effect of Counseling and Reminders in Improving the Follow-up Rate of Pediatric Patients (0-16 Years) at Bharatpur Eye Hospital, Nepal: an Intervention Study

Need: Childhood visual impairment and blindness remains an important public health issue. It is estimated that around 14 million children in the world are blind. Nepal Pediatric Ocular Disease study found that prevalence of blindness and visual impairment in the community was 0.068% (95% CI 0.02%-0.12%) and 0.097% (95% CI 0.04%-0.15%) respectively. Increasing the global knowledge base for planning for childhood eye care services is a top priority in order for children with visual impairment to realize their full visual potential. Follow-up of pediatric patients is important for their regular ocular morbidity monitoring, especially for amblyopia management. A study done in India revealed distance and cost as major barriers, as was the inability of the eye care center to communicate the importance of follow-up. Another study done in Nepal found poor follow-up rates for post-cataract surgery patients which however improved after implementation of a post-operative follow-up program.

Bharatpur Eye Hospital observed that there is poor adherence to follow-up visits. An observatory data of 1st week (1st to 7th) of January 2019 revealed that the follow-up compliance was very low among children aged 0-16 years in the pediatric department. Among the children advised for follow up only 22% were found to have come for at least one follow-up visit. Therefore, there was the need to implement measures to improve the follow-up rate.

Potential impact: High-quality pediatric counseling service, follow-up program, tracking system, and cell phone reminders resulted in the improved follow-up of pediatric patients in Lumbini Eye Institute, Nepal.6 Many studies have compared different methods of reminder options like telephone calls, email, SMS in order to improve the compliance to followup.7,8,9,10. Bharatpur Eye Hospital aims to find the effectiveness of counseling and reminders through SMS and phone calls on improving the follow-up rates of pediatric patients.

Bharatpur Eye Hospital assumes that with the proposed intervention the follow-up rate would increase to 50% considering the similar increase in follow-up rate in postoperative cataract surgery patients done in Lumbini Eye Institute (around 20% increase in follow up)6. In addition to it, another study done in London showed the use of SMS reminders for ophthalmology outpatient appointments reduced the non-attendance rates by 6.9%.18Improving follow-ups of patients is important to meet the treatment goal and provide effective and complete treatment for particular ocular problems. Adherence to follow-up is even more vital for children because the visual system is still in the developing phase in young children and loss of follow-up may lead to loss of vision. So, for quality treatment, patient satisfaction and improvement of the visual status of children, and revenue generation for the hospital it should be the priority area for the hospital to find ways for improving the existing low adherence to follow up in pediatric patients.

Study site: Bharatpur, Chitwan is located in the central part of the country, which is 150 K M. west from Kathmandu and 130 K. M. east from Lumbini (Bhairahawa) with an area of 2218 sq. Kilometer. The hospital, named Bharatpur Eye Hospital is located in the delightful city of Bharatpur, the capital of Chitwan district, by the bank of Narayani River, a place of pilgrimage of the Hindus. It is a tertiary eye hospital that ranks first among the eye hospitals in Nepal.