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E. Vukovic, A. M. Tjiam, W. A. Asjes-Tydeman, S. E. Loudon, M. Sinoo, H. N. E. van Agt, H. J. de Koning, H. J. Simonsz; Non-Compliance in Occlusion Therapy for Amblyopia Can Be Improved, but Can Such Measures Be Implemented Nationwide?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2584.
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We previously found that compliance in patching for amblyopia is low when parents do not speak the national language; an educational program improved compliance (IOVS 2006;47: 4393-400). Whether this program can be implemented in low-socio-economic status (SES), non-native, suburban areas in the Netherlands is studied now.
Baseline knowlegde and attitude of orthoptists towards compliance are assessed on the yearly basis with an anonymous questionnaire sent to all orthoptists in the Netherlands (n = 350). Participating orthoptists in the study are observed during one year before and one year after the introduction of the compliance-improving program, accompanied with courses on compliance. Compliance is measured electronically. The factors influencing implementation are assessed by a qualitative interview and by systematic observation of the orthoptists in practice. Endpoints at the level of the orthoptist comprise knowledge, attitude and practical skills about non-compliance, overall visual-acuity and compliance increase per orthoptist. Endpoints at the level of the child comprise compliance, demographic factors, parental fluency in Dutch, quality of life during patching, appointment attendance and improvement of acuity.
Nine orthoptists in four low-SES, non-native, suburban areas and 23 orthoptists nationwide participate. Electronically measured compliance in these suburban areas is appalling: approx. 45% of the prescribed therapy is hardly or not carried out. Logistic problems in local organizational structures hamper the implementation study itself. Although the involved hospitals were generally eager to participate, some now demand that their orthoptists take a day off for the courses and seem reluctant to support their orthoptists to make actual changes . Identified obstacles for implementation of compliance-enhancing measures are: Magnitude of the problems in communication with parents who do not speak the national language, conflicts of interest between national health purposes and purposes in private practise, uncertainty about the responsibility for failing therapy, long waiting times for appointments, visit to the orthoptist too short to include adequate explanation. The participating orthoptists report an increased awareness of compliance and its related issues.
Implementation of compliance-enhancing measures is slow.
Clinical Trial: :
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