Task shifting in primary eye care: how sensitive and specific are common signs and symptoms to predict conditions requiring referral to specialist eye personnel?

Human Resources for Health

Research

Khumbo Kalua¹  Susan Lewallen²  Paul Courtright²  Hery Harimanitra Andriamanjato³  Wanjiku Mathenge⁴ 

[1] Blantyre Institute for Community Ophthalmology and Ministry of Health, Lions Sight First Eye Hospital, Blantyre, P.O. Box E180 Post Dot Net, Blantyre, Malawi;Department of Ophthalmology, University of Malawi College of Medicine, P/Bag 360, Blantyre, Malawi;Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, South Africa;University of Cape Town, Department of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa;Ministry of Public Health, Antananarivo, Madagascar;Rwanda International Institute of Ophthalmology, Kigali, Rwanda;

关键词: primary eye care;    task shifting;    blindness;    Africa;    ocular symptoms;    ocular signs;    soins de la vue primaires;    délégation de tâches;    cécité;    Afrique;    symptômes oculaires;    signes oculaires;   

DOI  :  10.1186/1478-4491-12-S1-S3

来源: Springer

【 摘 要 】

BackgroundThe inclusion of primary eye care (PEC) in the scope of services provided by general primary health care (PHC) workers is a ‘task shifting’ strategy to help increase access to eye care in Africa. PEC training, in theory, teaches PHC workers to recognize specific symptoms and signs and to treat or refer according to these. We tested the sensitivity of these symptoms and signs at identifying significant eye pathology.MethodsSpecialized eye care personnel in three African countries evaluated specific symptoms and signs, using a torch alone, in patients who presented to eye clinics. Following this, they conducted a more thorough examination necessary to make a definite diagnosis and manage the patient. The sensitivities and specificities of the symptoms and signs for identifying eyes with conditions requiring referral or threatening sight were calculated.ResultsSensitivities of individual symptoms and signs to detect sight threatening pathology ranged from 6.0% to 55.1%; specificities ranged from 8.6 to 98.9. Using a combination of symptoms or signs increased the sensitivity to 80.8 but specificity was 53.2.ConclusionsIn this study, the sensitivity and specificity of commonly used symptoms and signs were too low to be useful in guiding PHC workers to accurately identify and refer patients with eye complaints. This raises the question of whether this task shifting strategy is likely to contribute to reducing visual loss or to providing an acceptable quality service.

【 授权许可】

Unknown   
© Andriamanjato et al; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.