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Atalie C. Thompson, Matthew Thompson, Steven R. Sanislo, Darius M. Moshfeghi, Mark Blumenkranz, Richard C. Lin, Kuldev Singh; Barriers to Eye Care Service Utilization and Potential Strategies to Improve Follow-up in Patients With Glaucoma, AMD, and Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1432.
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To understand noncompliance with follow-up appointments for Glaucoma (GL), AMD, and Diabetic Retinopathy (DR) and to propose potential strategies to improve compliance.
One hundred nineteen GL, 86 AMD and 33 DR patients attending follow-up appointments at Stanford eye clinics between June and November 2009 were surveyed regarding demographics, travel, insurance, education, knowledge of their eye disease and importance of follow-up using a modification of a questionnaire previously validated at Aravind Eye Hospital. Eligibility criteria included at least one follow-up visit over the prior 12 months and age >18 years. Poor follow up was defined by a missed scheduled appointment or cancellation of at least 3 appointments over the year preceding the study. All subjects were asked to complete the Visual Functioning Questionnaire-25.
Forty-eight percent of GL, 56% of AMD, and 69% of DR subjects were classified as having poor follow-up. A higher proportion of poor follow-up patients were non-whites and lacked private insurance. Twenty-seven percent of poor follow-up AMD patients were uncertain if they required treatment for life compared to 13.2% of those with good follow-up. Thirty percent of poor follow-up DR patients versus 10% with good follow-up were unsure whether or not DR was related to blood vessel damage in the eye. Twenty-one percent of poor follow-up and 11% of good follow-up GL patients were unsure if their vision loss was permanent. Compared to good follow-up (55.3% AMD, 50% DR), a greater proportion of poor follow-up patients (62.5% AMD, 85.2% DR) relied on an escort for transportation. GL patients with poor follow-up (29.2%) more frequently reported missing their eye-drops in the past week (14.6% good follow-up). More than one third of patients in all groups felt they would benefit from knowing other people with their eye condition (39.9%), more education on their eye disease (37.3%), and transportation services to the clinic (44.1%).
Poor follow-up is highly prevalent among patients with GL, AMD and DR. Improvement in patient education and networking, as well as provision of affordable transportation services for patients who otherwise rely on escorts due to poor vision may improve compliance with follow-up appointments.
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