iScreen-study: online eye screening in home care

Why are we doing this study?

In the Netherlands, the prevalence of blindness and visual impairment is highest among elderly in care institutions and in home healthcare (20-25%). The number of people of 65 years and older, with severe visual impairment is estimated at 250,000, more than half of which can be prevented by using glasses or a relatively simple ophthalmic procedure. Having visual impairment can lead to depressive complaints, falls and fractures and has a significant impact on quality of life and participation.

In 2018, 560,000 people of 65 years or older received care at home due to health problems (CBS, central bureau for statistics). A recent pilot study in collaboration with ‘Buurtzorg Netherlands’ (a Dutch home healthcare organization) showed that a simple eye screening by home healthcare nurses contributes to the detection of eye complaints in elderly people living at home. Although more than 20% was referred to the general practitioner or optometrist for the first time by the nurse, half of the patients actually made use of it. Of all patients, 20% appeared to have severe visual impairment and of all referred patients, approximately 40% appeared to have severe visual impairment, which in most cases could be treated with glasses or cataract surgery. The number of falls was significantly higher for people with visual impairment (i.e. 52% vs. 38%).

Eye screening of vulnerable groups appears to be an effective public health intervention. However, despite temporary success, for example in nursing homes, initiatives for eye screening do not always last. Research into the perspective of the elderly who receive home healthcare, the perspective of home healthcare nurses, professionals who provide eye care and society can provide insight into the efficiency and support for the implementation and perception of eye screening in home healthcare. In addition, possible barriers and facilitators for the implementation of this intervention should be investigated.

What is the aim of this study?

The overarching aim of the study is to gain insight into the public support for the implementation of nurse-supported online eye screening in home healthcare. The support is examined from different perspectives; that of the elderly patient, eye care professionals, the socio-political context and the societal perspective.

How do we conduct this study?

The research consists of in-depth interviews, a randomized trial on the cost-effectiveness of eye screening and a conference to discuss implementation with stakeholders. In addition, some measurement properties of online eye screening in the setting of home healthcare are investigated. The online eye screening consists of measurements for near and far vision, as well as central visual field (Amsler) and contrast vision. The iScreen study is being conducted by Amsterdam UMC together with ‘Buurtzorg Netherlands’, ‘Cordaan’ and ‘Easee BV’ and contributes to the prevention of avoidable visual impairment.

Results phase 1:

Results: Implementation factors that were identified; sufficient evidence for (cost) effectiveness of the tool, perceived benefits of screening (e.g. preventing falls, improving participation and quality of life) and user-friendliness can facilitate implementation, as well as a clear referral process and embedding in the current reimbursement by health insurance companies. Nurses’ job perception was both enabling and inhibiting; for older, less digital patients, nurses can provide added value in screening and also provide reliability of the outcomes. Some relatives or patients may be able to use the tool without the help of the nurse. With regard to organizational readiness and support for implementation, a clear customized plan for implementation was considered essential. Finally, the implementation of the online tool was expected to contribute to a greater awareness of previously undiscovered preventable visual impairment.

Discussion: There was general support among stakeholders and patients for the implementation of nurse-assisted online eye screening in home healthcare. People were satisfied with the tool and the added value was mentioned several times. Organizational readiness at the nurse- and management level, including adequate capacity and support is essential. However, not all patients are expected to require help from the nurse, therefore a decision aid could be developed to implement the eye screening for those who need it most to contribute to public health. Future evaluation of the cost-effectiveness of eye screening in home care is needed and a tailor-made implementation plan to address identified barriers and facilitating factors.