Cataract Surgery Care (CSC): A Pilot Study Analyzing the Efficacy of a Collaborative Approach to Postoperative Ophthalmic Care

Students

2018
College

Faculty

Professor, Director of the Center for the Advanced Study of India

Project Summary

The Aravind Eye Hospital (AEH) chain in South India provides high-quality, inexpensive care to millions of patients per year.The backbone of Aravind’s workforce is comprised of Mid Level Ophthalmic Personnel (MLOPs), young women who are trained for specialized nursing duties within the hospital. One such specialty is counseling, and MLOPs in this vital role ensure that patients and their families are fully informed on the details of consults and procedures. In addition to the paying patient group, Aravind is accessible to a diverse patient population due to rural camp outreach and subsidized or free surgeries for low income individuals. In particular, cataract surgeries dominate the majority of Aravind’s procedural workload. In 2015-2016 alone, 262,752 cataract surgeries were performed across Aravind’s branch hospitals. Patient education is essential in producing positive patient outcomes following cataract surgery. As a result, post-operative instructions must be dispensed to patients in a manner that alleviates concerns about recovery and encourages compliance in applying eye drops and maintaining proper eye hygiene.

MLOP counseling is essential in facilitating a smooth recovery, but one-on-one counseling tends to be inefficient and lacks consistency. This time-consuming protocol also detracts from the clinical efforts of the MLOPs in providing attentive patient care. In order to optimize the counseling process to benefit both the MLOPs and the patients, AEH branch in Pondicherry recently proposed a group counseling approach to present post-operative instructions to patients, known as Cataract Surgery Care (CSC). The expected benefits of this model were an increase in efficiency and consistency of instruction, with the added advantage of increased patient morale through the creation of a supportive group environment. The new framework involved a multimedia presentation with audio, images, and text in order to reach patients of high and low health literacies. The MLOPs also moderate a time in which patients can ask questions and learn from each other’s concerns and prior experiences. My primary project this summer involved further implementing and evaluating the effectiveness of group counseling through a pilot, questionnaire-based study in which patients were asked to provide feedback on outcomes, communication, and emotions following counseling. These results were compared to data collected following the traditional one-on-one counseling procedure.

We intended to reduce the amount of time necessary for MLOP counselors to provide thorough instructions and improve patient experience using three strategies: a multimedia presentation, an open question period facilitated by the MLOP, and the presence of group support. The open question period allows the MLOP to answer common questions, and for the patients to hear the questions of other patients. If a patient is uncomfortable asking questions, it is possible another patient might address these concerns in their inquiries. Lastly, the creation of a group environment may boost the community morale, eliminating the isolation that many patients feel when all aspects of care are individualized. Patients who may have previously had a cataract surgery may be able to reassure others, which is a meaningful personal connection that is lacking in one-on-one counseling.  

A Standardized Patient Experience Questionnaire (PEQ) was used to measure the patient’s counseling experience. Using this questionnaire, we hoped to investigate the differences between one-on-one and group counselling on the criteria of visit outcomes, communication experience, communication barriers, and emotions. For our test design, we used two experimental groups. The first included 64 patients receiving CSC, and the second included 58 undergoing traditional one-on-one counseling, or the control group.

Although a pilot study, our work demonstrated that CSC has several statistically significant advantages over the traditional one-on-one counseling method. The survey offered a simple yet accurate way of assessing patient feedback to determine if the change in counseling strategies are ultimately effective. Patients had a more positive view of their outcomes and experiences following CSC as compared to the older strategy. In addition to these patient-centric benefits, the MLOPs also report having increased time to provide high-quality care in the clinic. This nontraditional solution allows the MLOPs to thoroughly fulfill their role as a point of reassurance and a source of information for patients, while reducing the burden of additional time that individual counseling places on their clinical duties. Confidentiality is not breached using the method, rather sharing of information with others is voluntary from the patient side. Given the extremely high volume of cataract surgeries performed at Aravind, there is a strong need for efficiency and efficacy in all aspects of care, including counseling.

I have been involved in clinical research at CHOP since August 2015 working under Dr. Virginia Stallings, who was supportive of this unique, funded opportunity to expand upon my interests in ophthalmology while conducting my own research. Being able to design and carry out an independent research project abroad was both challenging and exciting, and the generous funding from CURF and the Center from the Advanced Study of India (CASI) allowed me flexibility in planning innovative and meaningful projects. This research experience has been personally and professionally fulfilling and will be an asset in the future as I move towards a medical career. I look forward to returning to India in the next 1-2 years to follow-up with my projects.