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W. L. Marsh-Tootle, G. McGwin, T. C. Wall; A Web-Based Intervention Can Improve Knowledge About Strabismus, Amblyopia and Preschool Vision Screening. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4354.
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To evaluate the effectiveness of a web based intervention to improve knowledge regarding strabismus, amblyopia, and preschool vision screening ("vision") in primary care settings.
Eligible providers filed Medicaid claims in AL, SC or IL, for at least 8 well-child checks at ages 3 or 4 years during a year before enrollment. Participants accessed four sequential web-based modules with physician targeted, interactive case vignettes and tool kits designed to enhance care for children. At log-in, participants were randomly assigned to intervention modules about vision (N= 65) or control modules about pediatric blood pressure or Chlamydia screening (N=71). Intervention participants (IPs) answered vision questions at baseline (before presenting guidelines or evidence based practices), after a short term delay (questions repeated after module 1), and after a longer delay (questions repeated after module 4). Control participants (CPs) answered the vision questions only once, after finishing control module 4.
Responses were available from 57 of 65 IPs who completed vision questions at baseline and after the short delay, as well as a subgroup of 27 IPs and 42 CPs who completed questions at the end of their final module. The short term delay was within one hour after initial log on for more than half (N=38) the IPs. For 18 IPs, the short delay was 1 hour to 17 days, while one IP took 390 days. The long delay averaged 1.8 years (range 0.81 to 2.69 years) after IPs initially logged in. Responses for 6 of 7 items significantly improved over baseline after the short delay. Performance on the 7th item was high at baseline (87.7%) and did not improve further. IPs initial median score was 4 of 7 correct. Scores improved to 6 correct after the short term delay (p=0.0065). Vision scores from 42 CPs were not significantly different from IPs at baseline (p= 0.6473) but IPs scores were significantly higher than CPs after the short (p<0.0001) and long-term delay (0.0371). Final scores were obtained about the same time from IPs and CPs.
The web-based intervention significantly improved knowledge about vision, in pre-and post-intervention comparisons within intervention providers, and between a subset of control and intervention providers conducted approximately 2 years later. Despite many reminders to complete the modules, fewer than half the IPs finished. Therefore, additional efforts will be necessary to sustain the improvements that can be achieved with the web-based intervention.
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