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      Eye care utilization patterns in Tehran population: a population based cross-sectional study

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      1 , , 2 , 3 , 1
      BMC Ophthalmology
      BioMed Central

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          Abstract

          Background

          The aim of this study is to determine eye care visits which are an indicator of eye care service utilization by Tehran population and its determinants.

          Methods

          Through a population-based, cross-sectional study, 6497 Tehran citizens were sampled. All participants had complete eye examinations and an interview regarding demographic and socioeconomic status variables, past medical and eye history, and their previous and last eye care visits.

          Results

          Among those sampled, 4565 people participated in the study (response rate of 70.3%). Among these participants, 34.7 % had never visited an ophthalmologist or optometrist (95% confidence interval [CI]: 32.4 to 36.9) and 43.2% had not seen an eye care provider in the last 5 years. Multivariate logistic regression revealed that men (OR = 1.30), younger participants (each year increase in age: OR = 0.98) and the less educated (each year increase in education: OR = 0.93) were more likely, and the visually impaired were less likely (OR = 0.41) to have neglected eye care.

          Conclusion

          A large proportion of the population, including those in the high risk group who require eye care, has never utilized any eye care service. These data suggest that efforts have to be made to better understand the causes and to optimize the utilization of the available eye care services in the population.

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          Most cited references16

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          Hospitalization rates as indicators of access to primary care.

          Variations in hospitalization rates for selected conditions are being used as indicators of the effectiveness of primary care in small areas. Are these rates actually sensitive to problems in local primary care systems? This study examines the relationship between ambulatory care sensitive condition (ACSC) hospital admission rates and primary care resources and the economic conditions in primary care market areas in North Carolina in 1994. The data show a high degree of correlation between the rates and income but not primary care resources. The distribution of rates did agree with expert assessments of the location of places with poor access to health services. The data confirm that access to effective primary care reflected in lower rates of ACSC admissions is a function of more than the professional resources available in a market area. The solution to reducing disparities in health status may not lie within the health system.
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            Utilisation of eye care services in rural south India: the Aravind Comprehensive Eye Survey.

            To determine utilisation of eye care services in a rural population of southern India aged 40 years or older. 5150 subjects aged 40 years and older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers before ocular examinations. 3476 (72.7%) of 5150 subjects examined required eye care examinations. 1827 (35.5%) people gave a history of previous eye examinations, primarily from a general hospital (n = 1073, 58.7%). Increasing age and education were associated with increased utilisation of eye care services. Among the 3323 people who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of individuals with vision impairment, cataracts, refractive errors, and glaucoma had previously utilised services. A large proportion of people in a rural population of southern India who require eye care are currently not utilising existing eye care services. Improved strategies to improve uptake of services is required to reduce the huge burden of vision impairment in India.
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              Low uptake of eye services in rural India: a challenge for programs of blindness prevention.

              To investigate service uptake in a rural Indian population served by outreach eye camps and to identify barriers to uptake. A routine eye camp was conducted within 5 km of each of 48 randomly selected villages of typically Hindu, backward-caste communities. Subsequently, participatory rural appraisal-community mapping, focus groups, matrix ranking, and semistructured interviews-was undertaken to explore community views of eye problems. An eye examination was conducted on persons with eye problems who did not attend the eye camp. Predictors of attendance were identified by multilevel regression analysis. Of 749 adults with an eye problem, 51 (6.8%) attended the eye camp. Independent predictors of attendance were being male (odds ratio = 2.3; 95% confidence interval, 1.2-4.5) and living within 3 km of the camp (odds ratio = 4.5; 95% confidence interval, 1.7-12.5). Of the 552 persons who did not attend the eye camps and had an eye examination, 242 (43.8%) had low vision (visual acuity or =3/60 in presenting better eye) and 38 (6.9%) were blind in both eyes. Cataract surgery was recommended for 197 (35.8%) of the persons who did not attend the eye camps. Of 109 persons with a previous cataract operation, 42 (38.5%) had low vision and 11 (10.1%) were blind. Fear (principally of eye damage), cost (direct and indirect), family responsibilities, ageism, fatalism, and an attitude of being able to cope (with low or no vision) were the principal barriers to attending the eye camps. A high proportion of people who could have benefited from eye treatment were not using available services. Poor visual outcomes were observed in surgically treated persons.
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                Author and article information

                Journal
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                2006
                20 January 2006
                : 6
                : 4
                Affiliations
                [1 ]Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [2 ]Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
                [3 ]Noor Vision Correction Center, Tehran, Iran
                Article
                1471-2415-6-4
                10.1186/1471-2415-6-4
                1382253
                16423308
                914b42ab-6696-44b1-b3e5-e07cfb09514c
                Copyright © 2006 Fotouhi et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 June 2005
                : 20 January 2006
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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