VIP-path study: referral from ophthalmologist to low vision services

Why are we doing this study?
In the Netherlands, there are an estimated 300,000 people with a visual impairment. A visual impairment can have a huge negative impact on the daily functioning, social participation and quality of life of those affected. In addition, there is an increased risk of depression, anxiety, falls and bone fractures.

According to the guideline ‘vision disorders: rehabilitation and referral’ of the Dutch Society of Ophthalmology, ophthalmologists (or sometimes other medical specialists) can refer to low vision services (LVS) at three national multidisciplinary LVS centers (Royal Dutch Visio, Bartiméus and Robert Coppes Stichting) when medical care is not sufficient enough to meet the patients’ needs. LVS focuses on coping with visual impairment, increasing visual functioning, independence and participation. Previous studies have shown that some of these services were found to be effective in enhancing quality of life of people with severe visual impairment.

Despite the benefits of LVS for people with severe visual impairment, not everyone who would potentially benefit from these services seems to utilize them. Some may have still sufficient support from their family or peers or may not feel the need (yet) for supporting services. Others may not be aware of LVS or may have been referred very late although they would have benefit from LVS. It remains unclear why some people do have access to or utilize LVS and some do not.

Wat is the aim of this study?
The aim of the “VIP-path study” is to examine why and how some people have access to or utilize LVS and some do not. Insights from this study may lead to the detection of (sub)optimal referral pathways to LVS. It also may provide policy makers with suggestions about how to enhance access to LVS.

• To examine barriers and facilitators in the access to and utilization of LVS from the perspective of patients with visual impairment and professionals from different healthcare providers involved in the eye care chain towards LVS.
• To examine predictors of referral to LVS of people with severe visual impairments based on health insurance claims of medical specialist (eye)care and LVS.
• To examine characteristics (such as anxiety, depression, personality traits and acceptance of the impairment) of patients treated in the ophthalmic care associated with (no) referral to and/or (no) utilization of LVS.

How do we conduct this study?
The ‘VIP-path study’ consists of various sub-studies, namely: an interview study, a big data study based on healthcare claims data from health insurers and a survey study. Different research methods will be used for the various sub-studies.

Promotores
Prof.dr. Ger van Rens, Prof.dr. Ruth van Nispen

Interview study

Referral to low vision services from the perspective of healthcare professionals and patients

This interview study (qualitative study) aims to examine barriers and facilitators in the access to and utilization of LVS from the perspective of patients with visual impairment and professionals from different healthcare providers involved in the eye care chain towards LVS.

For this study, we will talk to patients and professionals from different healthcare providers (such as ophthalmologists and optometrists). During (telephone) interviews, we will ask them about the patient-provider relationship and their conversations with each other during a consult. We will also ask them about the information provision about LVS (Royal Dutch Visio and Bartiméus and, if applicable, the reasons of patients for (not) utilizing LVS. After finishing the interviews, focus groups will be organized for validation of the results from the interviews regarding barriers and facilitators in the access to and utilization of LVS. That means that we will examine whether other patients and professionals recognize themselves in the outcomes from the interviews.

Vektis-study (Big data)

Predictors of referral to low vision services

The aim of the Vektis-study is to examine predictors of referral to LVS of people with severe visual impairments based on health insurance claims of medical specialist (eye) care and LVS. Specifically, predictors regarding socio-demographic, clinical and contextual characteristics of LVS patients, as well as other healthcare utilization of patients using LVS will be explored.

The Vektis-study is a retrospective ‘big data’ study. That means that a large amount of data is used (big data) and that we look back in time (retrospective). This study is based on a Dutch national health insurance claims database retrieved from Vektis C.V, which continuously collects healthcare claims of all Dutch insurers. For this study, claims data between 2015 and 2018 of all visually impaired adults, aged 18 or older, who received LVS will be collected. Besides that, claims data of patients with macular degeneration, glaucoma and diabetic retinopathy and other diagnoses that are common in the study population who have been treated in the medical specialist eye care will be retrieved.

With these healthcare claims data we aim to get insight into socio-demographic, clinical and contextual characteristics of LVS patients, as well as other healthcare utilization of patients using LVS that (not) lead to referral to LVS.

Survey study

Patient characteristics associated with referral to low vision services

The aim of this survey study is to examine which characteristics (such as anxiety, depression, personality traits and acceptance of the impairment) of patients treated in the ophthalmic care are associated with (no) referral to and/or (no) utilization of LVS.

For this study psychometrically sound instruments will be used to investigate to what extent patient characteristics such as personality, illness perception, health literacy, social support, quality of life, anxiety, depression and acceptance of the impairment of people who are visually impaired are associated with the referral to and/or utilization of LVS.