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A. M.-L. Tjiam, E. Vukovic, W. L. Asjes, S. E. Loudon, M. Sinoo, H. N. E. van Agt, H. J. de Koning, H. J. Simonsz; Implementation of a Compliance-Enhancing Program for Occlusion Therapy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4886.
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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). Now this program is implemented in the Netherlands, first in low-SES suburban areas, then nationaly.
Baseline knowlegde and attitude of orthoptists towards compliance were assessed. An anonymous questionnaire was developed, consisting of the following domains: knowlegde of non-compliance in general, occlusion therapy and non-compliance in own practice and relationship with patients. It was sent to all orthoptists in the Netherlands (n = 350).Currently, in the first year of the main study, orthoptists registered all new amblyopic children and treated as they always did. Compliance will be measured with Occlusion Dosed Monitor, only in the low-SES. Meanwhile, the factors influencing implementation are being assessed by a qualitative interview and observing the orthoptists in practice. Thereby, to increase the ability to implement the educational program, strategies like motivational interviewing will be developed and a course on non-compliance will be given at the beginning of the second year. In the second year, the new registered children will receive the educational program. The orthoptist will implement the strategies learned during the course en motivational interviewing.
51% of all orthoptists in the Netherlands returned the basline questionnaire. 65% answered that they can recognise non-compliance, though only 3% responded having a lot of non-compliance in their practice. 41% give no extra explanation to parents, who speak the Dutch language poorly. For the main study 11 orthoptists in 4 hospitals located in the suburban areas of Amsterdam, Rotterdam, Utrecht and The Hague were recruited. 25 orthoptists in 13 hospitals were recruited for the national part of the study. Factors, influencing the implementation and the ability to implement are very diverse, therefore various strategies are developed for each orthoptist.Discussion: The baseline questionnaire showed that orthoptist are relatively unaware of the problems on non-compliance in their practice and strategies to cope with non-compliance are not wide spread. Organising this implementation study is difficult, but that is a part of the implementation itself. We observed that the studies on non-compliance in occlussion therapy have enhanced the awareness in the Netherlands, however.
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