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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Developing the specifications of an Open Angle Glaucoma screening intervention in the United Kingdom: a Delphi approach

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Susan E Campbell, Augusto Azuara-Blanco, Marion K Campbell, Jillian J Francis, Alexandra C Greene, Craig R Ramsay, Jennifer M Burr
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-447) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

JMB, MKC, JF, AG, and CRR had the original ideas for the study. All authors developed the protocol. SEC, AG, JB, CRR conducted the Delphi survey and performed the analysis. AAB gave clinical advice on each round of the Delphi process. All authors contributed to revisions of the paper.

Abstract

Background

Glaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT.

Methods

A two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility.

Results

Using a cut-off of a median rating of feasibility of ≥5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a ‘glaucoma risk score’ ascertained by questionnaire. The advisory panel recommended that further exploration of the feasibility of screening higher risk populations and detailed specification of the screening tests was required.

Conclusions

With systematic use of expert opinions, a shortlist of potential screening interventions was identified. Views of users, service providers and cost-effectiveness modeling are now required to identify a feasible intervention to evaluate in a future glaucoma screening trial.
Zusatzmaterial
Additional files 1: Attributes of candidate glaucoma screening tests. An explanation of the attributes of tests of visual function to be considered as part of a glaucoma screening intervention. (PDF 54 KB)
12913_2011_2430_MOESM1_ESM.pdf
Additional file 2: Feedback to participants from the round one Delphi. A summary of the responses from round one sent to all participants with their round two questionnaires. (PDF 69 KB)
12913_2011_2430_MOESM2_ESM.pdf
Authors’ original file for figure 1
12913_2011_2430_MOESM3_ESM.pdf
Authors’ original file for figure 2
12913_2011_2430_MOESM4_ESM.pdf
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