[Are the ophthalmology items of the French health record realistic?]
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Insights
French healthcare practitioners show poor knowledge and skills in performing essential pediatric ophthalmological screenings. The current health record schedule appears ineffective for early detection of sight-threatening conditions.
Area of Science:
- Ophthalmology
- Pediatrics
- Public Health
Background:
- French general practitioners are mandated to perform pediatric ophthalmological screenings.
- Screenings utilize a methodology within the child's health record (carnet de santé).
- The goal is early diagnosis of sight-threatening and life-threatening conditions like retinoblastoma.
Purpose of the Study:
- To evaluate the theoretical knowledge of practitioners regarding pediatric ophthalmological screening.
- To assess the clinical skills of practitioners in performing specific screening tests.
- To identify deficiencies in understanding and application of screening protocols.
Main Methods:
- A questionnaire-based study was conducted from December 2013 to September 2014.
- 42 practitioners (GPs, pediatricians, residents) in Normandy, France, participated.
- The questionnaire focused on two key items: red reflex and eyeball size assessment.
Main Results:
- Only 4 out of 42 practitioners correctly identified normal red reflex color.
- Most practitioners struggled with the red reflex test due to lack of knowledge on normality criteria.
- Difficulties were also reported in assessing normal eyeball size, with a lack of awareness of normality criteria.
Conclusions:
- Practitioners exhibit poor theoretical knowledge and low clinical skills for mandated ophthalmological screenings.
- The current French health record screening schedule may not effectively achieve its intended purpose.
- Improvements in training and screening protocols are needed to enhance early detection rates.
Purpose:
Since 2006, French general practitioners have had to carry out an ophthalmological screening for children, using a methodology contained within the child's health record (carnet de santé). The purpose of this screening is to allow an early diagnosis of sight-threatening as well as potentially life-threatening conditions (e.g., retinoblastoma). The aim of the present study was to evaluate the theoretical knowledge and the clinical skills of practitioners implementing the screening, with regards to two specific items of the health record screening schedule, by means of a questionnaire.
Material And Methods:
From December 2013 to September 2014, 42 practitioners (16 general practitioners, 14 pediatricians, 12 resident physicians) from four distinct locations in Normandy, France, were questioned using a questionnaire on two ophthalmological items of the French health record: one on red reflex and one on eyeball size.
Results:
Only four of 42 practitioners provided correct answers on the red reflex color. Thirty of 42 practitioners reported difficulties performing the red reflex test, mostly because they did not know the normality criteria and the purpose served by this test. Thirty-three of 42 practitioners declared that they found it difficult to know whether or not eyeball sizes were normal, mostly because they were unaware of the normality criteria. None of the practitioners provided the correct (to within ± 1 mm) mean horizontal cornea diameter in full-term newborns and adults.
Conclusion:
This study demonstrates that there is poor theoretical knowledge and a low level of clinical skill for practitioners performing the ophthalmological screening based on the French health record schedule. This schedule therefore does not seem to meet its purpose.
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