Cluster randomized trial to compare spectacle delivery systems at outreach eye camps in South India.
OBJECTIVE
To study the optimal method for delivery of spectacles at eye camps to maximize procurement and use.


METHODS
A cluster randomized controlled trial, undertaken in the catchment districts of Aravind Eye Hospital - Theni, in the state of Tamil Nadu, India. Community eye camps (n = 21) were allocated to offer one of three types of service for purchase of spectacles to correct refractive error: (1) Issuance of a prescription only; (2) booking orders for spectacles with subsequent delivery; (3) on-the-spot fitting and dispensing of spectacles. Follow-up questionnaires were administered 6 weeks after interventions to assess patient outcomes. The primary outcome measured was spectacle procurement at follow-up 6 weeks post-screening. Secondary outcomes included use of and satisfaction with spectacles. Reasons for purchase/non-purchase were also assessed.


RESULTS
Compared to those who were issued only a prescription and adjusting for distance from base hospital, spectacle procurement was significantly higher for those allowed to book spectacles for subsequent delivery (odds ratio, OR, 8.79, 95% confidence interval, CI, 4.61-16.78) and for those receiving spectacles on the spot (OR 13.97, 95% CI 8.12-24.05). Among those with spectacles at 6 weeks, spectacle use was nearly universal and satisfaction with spectacles varied between 92 and 94% among the three different dispensing modalities.


CONCLUSIONS
Making spectacles available on the spot is important to ensure procurement in a context where availability and access to dispensing opticians is poor.
Lions Aravind Institute of Community Ophthalmology (LAICO), Aravind Eye Care System , Madurai , India .
Dhivya
D
Ramasamy
Sanil
S
Joseph
Vijayakumar
V
Valaguru
Vinod P
VP
Mitta
Thulasiraj D
TD
Ravilla
Mary Frances
MF
Cotch
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003153:Community Health Services / Q000600:supply & distribution*; D003695:Delivery of Health Care / Q000379:methods*; D005139:Eyeglasses / Q000600:supply & distribution*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D055656:Prescriptions / Q000706:statistics & numerical data; D012030:Refractive Errors / Q000628:therapy*; D055815:Young Adult