Essential components of rehabilitation services provided to visually impaired people.

CLINICAL RELEVANCE: This study was conducted to determine the essential components in the delivery of vision rehabilitation services. The findings could be useful in the planning of vision rehabilitation services by optometrists or health managers. BACKGROUND: Appropriate models of delivering vision rehabilitation services are a challenge for service providers worldwide. Studies have not revealed the key characteristics of a suitable model for delivering vision rehabilitation services. This study investigated the viewpoints of the key informants for identifying the most important components of a suitable model for delivering vision rehabilitation services. METHODS: Semi-structured in-depth interviews were conducted with 19 participants including managers and service providers in Iran. All the interviews were recorded and transcribed verbatim. An inductive framework analysis approach was used to analyse the data. Qualitative analysis was done using the MAXQDA 10 software. RESULTS: Four main themes emerged from the data, including creating maximum access (three subcategories: screening for visual impairment, creating a stepped-model for service delivery, and public and professional awareness of vision rehabilitation services), early intervention (two sub-categories: timely identification of people at the onset of disability and starting off with counselling services), need for financial support (two subcategories: providing affordable visual aid equipment and insurance coverage), and informed and skilled personnel (two subcategories: training vision rehabilitation specialists and familiarity of the rehabilitation staff with the rehabilitation program). CONCLUSION: This study identified the key features of an appropriate model for providing vision rehabilitation services to blind and visually impaired people from the viewpoints of key informants who were experienced in providing vision rehabilitation services. The findings have valuable implications for policy-making and planning for vision rehabilitation services by the health system.

Performance payment challenges for family physician program.

CONTEXT: Payment mechanisms are one of the effective tools for achieving optimal results in health system. Pay for performance (P4P) is one of the best programs to enhance the quality of health services through financial incentives. Considering of implementing family physician program in Iran and the P4P system, it is essential to address the challenges of implementing P4P system in the family physician program. AIMS: This study aimed to investigate the challenges of implementation of P4P system in family physician program. SETTINGS AND DESIGN: The qualitative study was carried out at areas covered by Iran University of Medical Sciences in Tehran, Iran. MATERIALS AND METHODS: The semi-structured interview was conducted on 32 key informants in 2019. The sampling method was determined based on purposeful sampling. The topic guide of interviews was experiences in implementing of family physician program and challenges of implementing P4P system. Participants had least 5-year experience in the family physician program. STATISTICAL ANALYSIS USED: A framework analysis was used to analyze the data using the software MAXQDA 10. RESULTS: The current study identified 7 themes, 14 subthemes, and 46 items related to the challenges to successful implementation of P4P systems in the family physician program including family physicians' workload, family physician training, promoting family physician program, paying to the family physician team, assessment and monitoring systems, information management, and the level of authority of family physicians. CONCLUSION: The study results demonstrated notable challenges for successful implementation of P4P system which can helpful to managers and policymakers.

The Impact of Visual Impairment on Quality of Life.

Our goal was to identify and describe factors relating to quality of life (QOL) in subjects with low vision and blindness in Iran's Sistan and Baluchestan Province. This cross-sectional study was carried out in randomly selected subjects with vision disability who were covered by the Zahedan Welfare Organization in Zahedan, Iran. The following factors related to visual impairment were evaluated: visual field (VF), visual acuity (VA), and stereopsis. Data were collected using a demographic questionnaire and the Influence of Vision Impairment (IVI) questionnaire. One-hundred and twenty-one patients were enrolled for participation in the study. T-test analyses indicated that the mean QOL score for women was significantly lower than that for men (P < 0.001). Mann-Whitney U tests indicated that mean social (P = 0.003) and leisure (P = 0.009) QOL scores were significantly lower in participants without stereopsis. In addition, participants with tunnel vision scored lower on the mobility and self-care categories (P < 0.001) than others. The results of this study indicate that providing education, providing employment, improving, and expanding social programs for the blind and individuals with low vision people, especially women, are necessary.