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Elaine J. Zhou, Tavé A. van Zyl, Zhuo Su, Rohit Thummalapalli, Elizabeth K. Marvin, Susan H. Forster; Prescheduled Appointments as a Strategy for Improving Follow-up Rate Among At-risk Subjects Identified in a Glaucoma Screening Setting. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1398.
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To investigate whether pre-scheduled appointments given at the time of screening increases follow-up rates among participants identified as glaucoma suspects.
Underserved individuals ages ≥40 were screened in a local primary care or community health fair setting in the Greater New Haven Area. Screening modalities included visual acuity, automated perimetry, portable tonometry and ophthalmoscopy performed by an ophthalmology resident. Identified at-risk suspects were randomized to receive either a pre-scheduled appointment for a low-cost complete eye exam within 7-10 days of the date of screening (intervention), or counseling on their results and the importance of timely follow-up with no pre-scheduled appointment (control). Follow-up rates were determined via clinical records and phone surveys and analyzed using Fisher’s exact test with significance set at p<0.05.
Among 302 subjects screened between June 2010 and October 2011, 60 (20%) were identified as "glaucoma likely," of which 37 were available for post-hoc phone surveys and were included in the analysis. Thirteen subjects (35%) completed follow-up eye care, including 5 (26%) in the control and 8 (44%) in the intervention group. Overall, intervention resulted in no statistically significant impact on follow-up rates compared to controls (p=0.31). Among those lacking health insurance, however, intervention led to a statistically significant increase in follow-up rates (54% vs. 0%, p=0.02). Similarly, among those lacking car access intervention was associated with a statistically significant increase in follow-up rates (71% vs. 20%, p=0.04). Ethnicity (p=0.26), living alone (p=0.17), and not having an eye doctor (p=1.0) led to no statistically significant difference in follow-up rates within either group.
Pre-scheduling follow-up appointments to glaucoma suspects at the time of screening may prove both clinically valuable and cost-effective when offered specifically to individuals lacking either access to health insurance or access to a car. However, universal provision may not lead to a statistically significant increase in overall follow-up rates.
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