Online nurse-assisted eye-screening in home healthcare; implementation study and economic evaluation, from an individual, healthcare and socio-political perspective [iSCREEN-study]

Background/relevance: Worldwide, approximately 75% of all moderate to severe visual impairment and blindness is explained by uncorrected refractions or cataract, which are both perfectly treatable. In the Netherlands, the prevalence of blindness and low vision is highest among the elderly in care institutions and in home healthcare (20-25%). Interventions for the most common causes of visual impairment are cost-effective and might prevent early inpatient long-stay admissions. Patients receiving home healthcare as a partly dependent population living in the community, however, have not yet been considered to be a population at risk that could benefit from eye-screening. There is very little information or empirical evidence available on public support or the perceived need for eye-screening by patients or other stakeholders. There are also no studies available regarding cost-effectiveness and utility explaining benefits of eye-screening, subsequent referral and intervention uptake. Objective: The overarching goal of the research is to gain insight into the perceptions and public support for the implementation of eye-screening in home healthcare, using a nurse-assisted online tool. To decide whether eye-screening (and subsequent referral) should be introduced in home healthcare, contextual factors and characteristics of patients, professionals and the innovation itself should be investigated from various stakeholders’ perspectives: these are the individual, healthcare and socio-political context (Step 1), the societal context (Step 2), and a synthesis which will lead to an implementation strategy for future successful implementation of nurse-assisted eye-screening (Step 3). Methods: In step 1, a large qualitative study including interviews with all stakeholders, i.e. both patients and professionals (max. N=40) will be conducted taking relevant perspectives on the innovation and future implementation into account. In step 2, a cluster randomized controlled trial (RCT) from a societal perspective (N=270) including an extensive process evaluation will provide insight in the cost-effectiveness and cost-utility of nurse-assisted online eye-screening compared to care as usual. The primary outcome is the incidence of clinically relevant progress of 10 letters (2 lines) or more on the Colenbrander-1M visual acuity chart between baseline and 12 months follow-up. In step 3, an invitational conference will be organized to synthesize the four perspectives into an implementation strategy and operationalization. Knowledge dissemination, communication and implementation: Dissemination will take place via the national nursing platform (V&VN) for distribution and communication to all member (home healthcare) organizations, and also through the Eye Association, Macular Association and the Dutch Patient Consumer Federation and via the networks of experts involved in the study. Scientific papers will be submitted to Open Access journals and national journals. Social media and conference presentations will be used to reach the general and scientific public. The pragmatic design of the interview study, cluster-RCT with process evaluation and invitational conference, greatly stimulates the application of the results in clinical practice, and will reflect the perspectives of all stakeholders. Community participation: Community participation through involvement of patients and patient representatives in the project team and in different roles in every step of our study, will be crucial to investigate public support, stakeholders’ perceptions and cost-effectiveness of nurse-assisted online eye-screening. This way we expect patients, as well as the research team and professionals involved, to equally influence the decision making concerning our final implementation strategy and operationalization.