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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - EUSCREEN (Implementation of cost-optimized childhood vision and hearing screening programmes in middle-income countries in Europe)

Teaser

Summary

In our study, data on screening programmes is gathered in a network of professionals in 41 European countries and used in a disease/health system modelling framework to predict benefits and cost in the most optimal health system, taking regional diversity and organisational and resource requirements into account.
Screening programmes are tested in the County of Cluj in Romania for vision, and in three counties in Albania for hearing screening, where such screening programmes do not yet exist.

Work performed

A questionnaire was made by WP2 for inventory of vision, hearing and general screening programmes, with domains on demography, circumstances for screening, existing screening programmes and health systems, uptake, screening tests, diagnostics, treatment options, envisaged health benefits, societal costs and adverse effects in their country (www.euscreen.org). For each country, 3 Country Representatives (CRs) for vision, hearing and general screening were recruited. We had difficulty finding competent CRs who were willing to fill out the detailed questionnaire, which also stagnated in many cases. Data collection will be finished for most countries in the Autumn of 2018. By our collaborative effort we now have the largest set of data about vision and hearing screening ever. CRs from Russia, India, South Africa, Malawi, Rwanda, Colorado (USA) and Egypt, have also filled out the questionnaire.

The questionnaire data was analysed for vision screening by WP3. Eleven Country Reports have been compiled. A further 11 draft reports will shortly be available. Six draft reports have been received back from CRs following content validation checks, to be finalised soon. After the finalization of all country reports has been completed, the mapping of vision screening across all 41 countries can begin.
Interim results suggest significant disparity in vision screening programmes across Europe. There is little or weak evidence to support such screening programmes based upon existing data and/or country-specific contexts. There has been difficulty in obtaining information on the data of vision screening programmes on information such as â€œdiseaseâ€ prevalence, treatment costs and personnel costs.

For hearing screening (WP4), first countries or regions that had provided the most complete set of answers were evaluated. Country Reports have been completed for 15 countries or regions. Clarification answers returned by 9 countries were cross-checked and validated, and final Country Reports were made.
Interim results suggest there is wide variation in hearing screening programmes and procedures among countries and among regions within countries. There is little evidence to support such screening programmes based upon existing data and/or country-specific contexts. There is variability in the availability of neonatal hearing screening programmes and their organization. In some countries, neonatal hearing screening is only accessible in some regions or some hospitals. There is wide variability in the sequence of screening tests used for well-infant hearing screening and in particular for at-risk infant hearing screening protocols across countries and regions in Europe.

In WP5, micro-simulation models were developed for hearing and vision screening, using the MIcrosimulation SCreening ANalysis (MISCAN) model structure. Parameter values were obtained from observed data, literature review and expert discussions, with input on country-specific costs (for screening and treatment) and local circumstances that influence screening test characteristics. Input parameters on demography, attendance rates for screening and life time costs were adjusted appropriately for the specific settings of Cluj (Romania) and Albania. More accurate data will be collected throughout the implementation-studies in Cluj and Albania.

In the implementation of vision screening in the County of Cluj in Romania in WP6 first the nurses in the city of Cluj-Napoca (approx. 70% of the population of Cluj County) and those in other towns in the county (approx. 8%) were informed. Screening of children from marginalized communities like Roma was prepared and local Roma experts and community facilitators were involved in motivating the parents to allow access to screen their children.
Family doctor\'s offices in rural areas (approx. 30%) received an informational email about the project and were contacted via telephone (at least 3 attempts). Four courses were held to train medical personnel

Final results

On March 8th, 2019, the Annual Meeting of the EUSCREEN Study will be held in Poznan and all 100+ CRs are invited. We will report back to them the results of the questionnaires of all countries, present an analysis and review of the vision and hearing screening programmes in Europe and present a first prototype of the model.

Until now, we have identified the following barriers:
- Even in countries with highly developed screening programmes, good quality monitoring is lacking.
- Large regional differences exist (Germany, Austria, Italy, France, Spain, Belgium and UK).
- Communication about screening programmes across borders is limited.
- Culturally different approaches to healthcare influence the provision of screening, for instance, what children are eligible for screening.
- Health-care reform is needed for equity in health-care: All agree this is needed, but few consider it possible at short notice.