Determinants and outcome of unsuccessful referral after positive screening in a large birth-cohort study of population-based vision screening

Angela Tjiam, JH Groenewoud, Jan Passchier, Sjoukje Loudon, Miranda de Graaf, WC Hoogeveen, VK Lantau, RE (Rikard) Juttmann, Harry de Koning, Huib Simonsz

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PURPOSE The efficacy of population-based vision screening is hampered by unsuccessful referral after a positive screening test. We studied the nature and causes of unsuccessful referral in a 7-year birth cohort study of vision screening in Rotterdam, the Netherlands. METHODS All parents of children who had been unsuccessfully referred were asked whether they recalled the referral. Reasons for noncompliance, if any, were identified using semi-structured interviews. Screening records were checked for written evidence of the referral. The parents' fluency in Dutch and their socioeconomic status were also assessed. RESULTS Of the 561 screen-positive children, 129 (23%) had not been referred successfully. For the current study, 97 parents were successfully contacted. Of these, 14 parents had been willingly noncompliant and 83 said they were unaware of the referral, with 47% having poor to moderate fluency in Dutch. In 53 cases, the screening charts contained no written evidence of any referral. Amblyopia was identified in 3 of the unsuccessful referrals. CONCLUSIONS In this population-based screening program, 1 of 4 positively screened children was not successfully referred. Apart from parental noncompliance, the unsuccessful referrals can be explained by miscommunication, deficient documentation, and physician noncompliance with screening guidelines. An effective monitoring feedback system may improve the efficacy of child vision screening. (J AAPOS 2011;15:256-262)
Original languageUndefined/Unknown
Pages (from-to)256-262
Number of pages7
JournalJournal of AAPOS
Issue number3
Publication statusPublished - 2011

Research programs

  • EMC NIHES-02-65-01
  • EMC OR-01-60-01

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