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R.Meenakshi Sundaram
Senior Manager Outreach
Aravind Eye Care System
India.
Eye camp plays a vital role in reaching the untreated poor blind people in rural areas. The main objective of the camp is to create awareness among the people which leads an intervention to clear the backlog of avoidable blindness.
NEED FOR COUNSELLING:
A patient has stimuli which create hundreds of questions while the patient undergoes screening and further medication. A doctor or paramedical staff can not spend more time with the patient to clear the doubts and educate them. It is a psychological process that patient wants the doctor to spend more time whether it is a base hospital or a rural eye screening camp to attend their problems, clarify the doubts and fulfill their needs. Personal attention and adequate time to each patient in addition to the clinical service are definitely helping us to increase the patient satisfaction. This is also our responsibility to communicate the details of nature of defects, curative and preventive aspects of various problems, necessary medication etc. In the management aspect, optimum utilization of resources particularly the man-days of medical staff becomes a major challenge for any service provider.
The concept of introducing Patient Counselling is focusing the following three major areas.
- Increase the level of patient satisfaction
- Health Education in Eye Care
- Optimum utilization of the Manpower
PATIENT COUNSELLING IN ARAVIND EYE HOSPITALS:
Patient Counselling was introduced a decade back in the base hospital in view of increasing the patients satisfaction and proper communication of necessary medication and treatment. It was gradually build up and a well defined structure was introduced in the form of counselling department in the Outpatient services in base hospital. Now, it is helping the patients tremendously to take a decision to procede their medication. The patient counsellor was becoming an important factor in decision making process.
It also helps the institution to communicate all the aspects of recent advances in eye care services like phaco emulsification, foldable lenses, lasik surgery and so on. This concept of counselling in eye care services were gradually introduced in other specialty clinics in the base hospital and community outreach programs.
In an eye camp, the medical team consists of Doctors, Paramedical Ophthalmic Assistants, Optometrist, Camp organizer and Patient counsellor to screen all the patients with eye problems. Aravind Eye Camps are organized not only to identify the cataract patients but also the other common eye problems like Glaucoma, Retina, Diabetic Retinopathy, Refractive Errors etc. This is the greatest opportunity for the people in the rural areas to identify such problems in the earlier stage.
ARAVIND MODEL OF PATIENT COUNSELLING IN EYE CAMPS:
A screening camp is conducted as a joint venture by Aravind Eye Hospital and a community based Social Service Organization mainly for the benefit of poor segment of the community those who are not accessible with eye care services. The community based activities like camp site preparation, publicity for the camp, preparation of the camp site with all support facilities etc. The managerial guidance, all the clinical services, patients care, food, transport taken care by the hospital.
The screening protocol in the camp has been standardized as like outpatients services in the base hospital. Patients with eye problems are diagnosed in the camp site and surgeries are performed in the base hospital. It starts with registration and ends with counselling in a camp. The patient counsellors have a very high degree of accountability in terms of patients satisfaction, surgery acceptance rate, referral acceptance rate and spectacles acceptance rate. The productivity of the camp in terms of number of admissions, acceptance of referrals is highly depending upon the counsellors communication skills. The patients go through all the stages as shown in the above flow chart. At the end of the screening, the senior Doctor advises the patients for medication or operation or further medical intervention in the base hospital or to wear spectacles to restore the vision. The patients are guided to counselling area to pursue the patients to follow the advice. The counsellor who attends the camp takes care of
- gather the patients from final examination
- clarify the doubts in case of medicines or spectacles prescribed
- conduct in-depth counselling to the patients who are advised for cataract surgery
- convince them to accept surgery by explaining the consequences of not undergoing surgery
- getting consent from the patients/relative for surgery
- accounting the admitted patients
- counselling the patients who have systemic problems like asthma, hyper tension, cardiac problems, diabetes etc to get admitted with physician opinion and an attendant
- counselling the patients to come to base hospital if they require any specialty treatment
- following up the referred patients for specialty treatment
In-depth counselling at the campsite focuses;
- the details of diagnosis
- cause of blindness
- curative method
- need of surgery in case of cataract
- positive/negative consequences
- details of treatment/surgery at base hospital
- pre-operative and post-operative procedure
- health education on primary eye care
Counsellor is also responsible to continue counselling at the base hospital just prior to surgery, after surgery in the ward and at the time of discharge to follow the cautious procedure. She makes sure all the patients are operated unless there is a valuable reason for not operated. The counsellor is very keen to explain the operated patients to attend follow up camp after 30 days of surgery. She also keeps track with referred patients who had been identified with specialty problems in the camp site and referred to base hospital.
The counsellor submits the following particulars to outreach department for each camp.
- The number of patients screened
- Age and Gender break up
- Diagnosis details
- The number of patients advised for cataract surgery and surgery acceptance rate
- The number of patients advised for spectacles and spectacles acceptance rate
- Patients screened with specialty problems and referred to base hospital
- The number of patients has come to the base hospital for specialty treatment that had been referred through previous week camps
- The reasons for not operated patients
- Details of operated, discharged and pending cases for each camp
- The number of patients operated and attended follow up camp
This is used to monitor the outreach activity performance in a very scientific manner. This significant role of counsellor helps to improve the total quality management of outreach eye care services.
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