Continual improvement needed for rural Vision Centre program in India

Study finds that patients were significantly more satisfied following Vision Centre visits in a large village setting compared to a small village setting.

Location, journey time and vision technician treatment were all key factors in patient satisfaction at vision centers in India, according to a recent study.

“This study has shown that the location of [the] Vision Centre, convenience of journey, vision technician (trained ophthalmic person manned to run the Vision Centre) behavior with patients, optical delivery time and quality of spectacles are some of the most important factors that determined the patient perception about Vision Centre services in both large villages and small villages,” Vilas Kovai, MPhil, said in an e-mail interview with Ocular Surgery News.

Mr. Kovai is an associate public health specialist at the International Centre for Advancement of Rural Eye Care, Kismathpur campus, L.V. Prasad Eye Institute (LVPEI). He is also the lead author on the retrospective comparative study.

The study examined the differences between patient satisfaction for primary care vision services in large and small village settings at Vision Centres in Andhra Pradesh, India.

“The overall satisfaction levels of the Vision Centre experience at 78% and 69% were good. However, continual improvement is to be made in service time, staff performance, cost and quality of vision care, especially at more remote primary eye Care Centres,” Mr. Kovai and colleagues wrote in the study.

Location of Vision Centre, distance of journey and vision technician all impact patient satisfaction at Vision Centres in India, above. Images: Kovai V

Mr. Kovai said that high patient satisfaction can benefit not only patients, but also the Vision Centres. It can assist in raising patient participation, which can improve volume. Overall patient satisfaction helped influence the number of patients who sought services at the larger village vision care settings. Other reasons for a higher volume of patients, according to the study, could include location, patient awareness and equity issues — all factors that should receive further study.

“If the quality of medical practitioners’ services at village level improve … aspects of patient care, patient satisfaction improves and, in turn, enhances utilization of facilities,” Mr. Kovai said in the interview.

Study design

“LVPEI’s pyramidal model of care emphasizes the establishment of sustainable permanent facilities within communities, staffed and managed by locally trained human resources and linked effectively with successively higher levels of care,” Mr Kovai said. The study was focused on the Vision Centre program, the base of the pyramidal model of eye care, created by LVPEI, Hyderabad, India, in 2002. The Vision Centre program addresses lack of access to primary eye care services in rural India. The Vision Centres provide services such as correcting refractive errors; identifying eye problems, cataracts and other blinding conditions; and administering health education and referrals as needed while addressing the issues of quality, equity and sustainability. Screening and referral services are free at Vision Centres, and the charge for spectacles — a source of financial sustainability — is the same at all centers. Each Vision Centre serves a population of 50,000 living in 10 to 15 villages. It is designed to be a part of the primary health care network horizontally and is attached to the secondary level center vertically. Ten such Vision Centres are attached to one Service Centre.

“Relevant literature review indicates that patient satisfaction plays a major role in the acceptance of health care services. Although the Vision Centre is now considered an integral part of the Vision 2020: the Right to Sight Initiative, little evidence exists on the satisfaction of the target community with the services provided, which is also a key measure of health care quality,” the study authors wrote.

They examined the hypothesis that Vision Centre patients “in large villages would be more satisfied primarily due to ease and lower cost of accessing services compared with access to Vision Centre in small villages.”

The study authors created structured and unstructured questionnaires. A total of 62 patients from large villages and 65 patients from small villages were interviewed about their satisfaction with four Vision Centres in 2007. Two of the centers were easily accessible to the nearby rural population in “large village hubs” and two were located in remote areas in “small village hubs.” A large village hub was considered an area with a base population of about 20,000 with a developed marketplace, educational facilities and connection to other villages. A small village hub was considered a remote location with a base population of less than 5,000 and no market, educational facilities or connection to other villages.

Locations were randomly selected from the 30 Vision Centres in Andhra Pradesh, India.

Key finding

The study found statistically significant differences in all factors studied except for “easy-to-identify Vision Centre location” and “spectacles dispensing time” when contrasted with privately run optometry facilities.

In addition, 55% of patients in large village settings reported that their visit and dispensed spectacles had been “highly useful and valuable,” while 45% of patients in small village settings found the same. A total of 95% of patients in large village settings said their daily tasks in relation to vision had improved “a little (to some extent) or a great deal,” contrasted with slightly more than three-fourths of patients in a small village setting, the study found.

The role of Vision Centre technicians was key to outcomes, Mr. Kovai said. Every center has one vision technician to perform primary eye care functions. The technicians who can communicate effectively and develop public relationships are successful in serving a high volume of patients, he said.

Factors found to be important regarding the vision technicians’ behavior with patients included thoroughness, carefulness, competence and personal mannerisms. The vision technicians who are rated as good to the above characteristics are successful in getting a higher number of patients (mean: 18 patients per day). Also, the time spent between patient and vision technician was vital to satisfactory outcomes, Mr. Kovai said.

“This data indicates that the vision technician … factor is the key predictor of patient satisfaction with the Vision Centre. However, it may be argued that if the villages were well connected by good transportation facilities, patient satisfaction would be higher, and this in turn could lead to higher patient participation, which needs to be tested further,” he said. – by Erin L. Boyle

Reference:

• Kovai V, Rao GN, Holden B, Sannapaneni K, Bhattacharya SK, Khanna R. Comparison of patient satisfaction with services of vision centers in rural areas of Andhra Pradesh, India. Indian J Ophthalmol. 2010;58(5):407-413.

• Vilas Kovai, MPhil, is an associate public health specialist at the International Center for Advancement of Rural Eye Care, Kismathpur campus, L.V. Prasad Eye Institute. He can be reached at Donbosco Nagar, Rajendranagar, Hyderabad 500 086, India; +91-40-30615611; fax: +91-40-23548271; e-mail: vilaskovai@lvpei.org.