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Evaluation of alternate outreach models for cataract services in rural Nepal

BACKGROUND: Bharatpur Eye Hospital in Chitwan District, a primarily agrarian setting in south-central Nepal, reduced the number of diagnostic screening and treatment (DST) camps by one half (151 to 75) in an attempt to increase both the efficiency of its outreach program and the number of people tha...

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Autores principales: Kandel, Ram P, Rajashekaran, Sowmya R, Gautam, Maria, Bassett, Ken L
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860345/
https://www.ncbi.nlm.nih.gov/pubmed/20334695
http://dx.doi.org/10.1186/1471-2415-10-9
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author Kandel, Ram P
Rajashekaran, Sowmya R
Gautam, Maria
Bassett, Ken L
author_facet Kandel, Ram P
Rajashekaran, Sowmya R
Gautam, Maria
Bassett, Ken L
author_sort Kandel, Ram P
collection PubMed
description BACKGROUND: Bharatpur Eye Hospital in Chitwan District, a primarily agrarian setting in south-central Nepal, reduced the number of diagnostic screening and treatment (DST) camps by one half (151 to 75) in an attempt to increase both the efficiency of its outreach program and the number of people that go directly to the hospital for service. The Hospital evaluated the two program models in terms of program costs, cataract surgical utilization, hospital direct payment and patient equity. METHODS: The study is a prospective, before and after, study of the impact of an alternate outreach model on cataract service utilization patterns and cost per outreach camp and cost per cataract surgery at Bharatpur Eye Hospital, comparing the service years July 2006 to June 2007, with July 2007 to June 2008. Study findings were based on routinely gathered hospital and outreach administrative data. RESULTS: The total cost of the DST camps decreased by approximately US$2000. The cost per camp increased from US$52 to $78 and the cost per cataract surgery decreased from US$ 3.80 to $3.20. The number of patients who went directly to the hospital, and paid for cataract surgery, increased from 432 (17%) to 623 (25%). The total number of cataract surgical procedures at Bharatpur Eye Hospital remained very similar between the two service years (2501 and 2449, respectively). The presenting visual acuity and sex of the two cataract surgical populations were very similar (favouring women, 53 and 55% in the two years, respectively). A shift toward younger men and women occurred with a 245 (64%) increase in people age 50-59 years, and shift away from people age 70 years and older with a 236 (22%) reduction. The age and sex distribution of the direct paying patients were very similar in the two years. CONCLUSION: The new, more concentrated, more rural DST model of service delivery reduced overall outreach program costs, cost per cataract surgery transported, while increasing direct payments to the hospital, with a significant decrease in the number of people age 70 and older in the first year.
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spelling pubmed-28603452010-04-28 Evaluation of alternate outreach models for cataract services in rural Nepal Kandel, Ram P Rajashekaran, Sowmya R Gautam, Maria Bassett, Ken L BMC Ophthalmol Research article BACKGROUND: Bharatpur Eye Hospital in Chitwan District, a primarily agrarian setting in south-central Nepal, reduced the number of diagnostic screening and treatment (DST) camps by one half (151 to 75) in an attempt to increase both the efficiency of its outreach program and the number of people that go directly to the hospital for service. The Hospital evaluated the two program models in terms of program costs, cataract surgical utilization, hospital direct payment and patient equity. METHODS: The study is a prospective, before and after, study of the impact of an alternate outreach model on cataract service utilization patterns and cost per outreach camp and cost per cataract surgery at Bharatpur Eye Hospital, comparing the service years July 2006 to June 2007, with July 2007 to June 2008. Study findings were based on routinely gathered hospital and outreach administrative data. RESULTS: The total cost of the DST camps decreased by approximately US$2000. The cost per camp increased from US$52 to $78 and the cost per cataract surgery decreased from US$ 3.80 to $3.20. The number of patients who went directly to the hospital, and paid for cataract surgery, increased from 432 (17%) to 623 (25%). The total number of cataract surgical procedures at Bharatpur Eye Hospital remained very similar between the two service years (2501 and 2449, respectively). The presenting visual acuity and sex of the two cataract surgical populations were very similar (favouring women, 53 and 55% in the two years, respectively). A shift toward younger men and women occurred with a 245 (64%) increase in people age 50-59 years, and shift away from people age 70 years and older with a 236 (22%) reduction. The age and sex distribution of the direct paying patients were very similar in the two years. CONCLUSION: The new, more concentrated, more rural DST model of service delivery reduced overall outreach program costs, cost per cataract surgery transported, while increasing direct payments to the hospital, with a significant decrease in the number of people age 70 and older in the first year. BioMed Central 2010-03-25 /pmc/articles/PMC2860345/ /pubmed/20334695 http://dx.doi.org/10.1186/1471-2415-10-9 Text en Copyright ©2010 Kandel et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research article
Kandel, Ram P
Rajashekaran, Sowmya R
Gautam, Maria
Bassett, Ken L
Evaluation of alternate outreach models for cataract services in rural Nepal
title Evaluation of alternate outreach models for cataract services in rural Nepal
title_full Evaluation of alternate outreach models for cataract services in rural Nepal
title_fullStr Evaluation of alternate outreach models for cataract services in rural Nepal
title_full_unstemmed Evaluation of alternate outreach models for cataract services in rural Nepal
title_short Evaluation of alternate outreach models for cataract services in rural Nepal
title_sort evaluation of alternate outreach models for cataract services in rural nepal
topic Research article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860345/
https://www.ncbi.nlm.nih.gov/pubmed/20334695
http://dx.doi.org/10.1186/1471-2415-10-9
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