Purpose:
To assess barriers for children who fail vision screenings by primary care providers to obtain follow-up care with an ophthalmology specialist.
Methods:
Records were accessed retrospectively of children ages 3 to 14 who failed a vision screening between January 2009 and October 2010 at a private university health center, two community health centers, and a private pediatric primary care practice in New Haven County, CT. A phone survey, approved by Yale University Human Investigation Committee, was conducted in English or Spanish with parents of a simple random sample of 146 children 4 months after the screening to allow follow-up to be completed. Each survey took 20 minutes to complete and consisted of 37 questions with prompts of possible answers regarding family demographics, parent knowledge of child eye care, and barriers to follow-up. Data analysis was performed via Minitab 16 with p<0.05 as significant for Fisher’s exact test.
Results:
53 families completed the survey, 17 refused, 47 moved or disconnected their phones, 28 never answered calls, and one could not speak English or Spanish. The response rate was 75.7% (53 of 70 eligible). 37 families (69.8%) were aware of the screening failure; of these 23 (62.2%) followed up. Of the 14 informed families that did not follow up, one had scheduled but was still waiting for an eye appointment, one missed an appointment due to child sickness but had not rescheduled, three had difficulty scheduling an appointment, three forgot to schedule, three considered follow-up unnecessary, two had to miss work for an appointment, and one cited a lack of insurance. 70% of families with access to eye care knowledge followed up while 28.6% of those without did (p=0.08). Follow-up rate was 87.5% if the pediatric office scheduled eye appointments but 52% if the office left parents to schedule (p=0.11). Statistically significant difference in follow-up rates was found between children who had eye appointments (71%) and who had not (20%) before screening (p=0.047) and between children who had to wait less than 2 months (100%) and who had to wait longer (50%) for an eye appointment (p=0.013). Ethnicity (p=0.26), health insurance (p=0.71), family income (p=0.67), parent marital status (p=0.71), car access (p=1), and private/public primary care setting (p=0.48) led to no statistically significant difference in follow-up rates.
Conclusions:
To improve follow-up eye care access in children who fail vision screenings, pediatric offices should clearly communicate screening failures, immediately schedule appointments with eye specialists, educate parents on the benefits of timely intervention, and issue appointment reminders, especially targeting children without previous eye care access.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • screening for ambylopia and strabismus • visual acuity