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Quality of refractive error care in Malaysia: An unannounced standardized patient study
Duratul Ain Hussin1, Ling Lee2,3, Suit May Ho2
1Allied Health Sciences Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
Purpose:
Quality of refractive error services is an outcome for effective refractive error coverage for people requiring vision correction. Optical legislation has regulated optometrists and opticians providing refractive care in Malaysia since 1991. This study aims to evaluate the quality of refractive error care (Q.REC) in Malaysia by estimating the proportion of dispensed spectacles meeting optimal spectacle quality standards and factors associated with spectacle quality.
Methods:
Using the Q.REC Protocol, 18 recruited unannounced standardized patients (USPs) from Klang Valley, Malaysia received a baseline refraction and completed training on refractive care standards. Dispensed spectacles were compared with the baseline refraction to determine the proportion meeting quality indicators, and associations between practice characteristics and spectacle quality were analyzed using logistic regression. USPs also reported visual symptoms.
Results:
Eighty-six practices comprising 257 visits and 253 spectacles were assessed. The analysis indicated that the quality of dispensed spectacles were 30.8% (95% CI: 24.9%-37.4%) and 78.8% (95% CI: 73.7%-83.4%) for optimal and adequate indicators, respectively. The most frequent error observed was the cylindrical axes outside of the tolerance limits (56.6%). Focimetry was inversely associated with quality, with spectacles more likely to be suboptimal when performed (OR 0.48, 95% CI: 0.27-0.85, and p = 0.013). USPs who experienced symptoms with their dispensed spectacles were 41.1% of emmetropes, 21.4% of simple myopes, and 26.6% of astigmats/myopic astigmats.
Conclusions:
Despite established optical legislation, refractive error care quality in Malaysia appears suboptimal. This study underscores the importance of strengthening regulatory mechanisms to address the possibility of unqualified refractive care practitioners, adherence to standard operating procedure and continuous education for higher-quality refractive care in Malaysia.
