The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.
Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.
objeCtives: Drugs retail outlets constitute a major source of malaria treatment in developing countries requiring regular and accurate information for enhancing strategies for improving the use of Artemisinin-based Combination Therapy (ACT). The study analyzed the demand and sales pattern of antimalarial drugs in private retail outlets to assess the current state of compliance to policy. Methods: A prospective cross-sectional survey of randomly selected drugs retail outlets in Enugu urban, south east Nigeria, was conducted between May and August, 2013, to determine the types, range, prices and sales pattern of antimalarial drugs as well as concomitant medications, from pharmacies and patent medicine outlets. Data was collected and analysed for antimalarial drugs demanded for and sold by selfmedication, treatment by retail outlets and prescription from hospitals. Results: With a total of 1,321 dispensed antimalarial drugs, ACTs accounted for 72.7% while monotherapy was 27.3%. AMFm drugs contributed 32.7% (n = 314) of ACTs. 46.5% (614) of the drugs were dispensed from self-treatment by patients. Treatment by the retail outlets accounted for 35.8% (n = 473) while 17.7% of the drugs were dispensed from hospital prescriptions.
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