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B. W. Lee, Y. Murakami, M. T. Duncan, A. A. Kao, J.-Y. Huang, K. Singh, S. Lin; Barriers and Ethnic Disparities Associated With Poor Follow-Up in Patients With Glaucoma in a County Hospital Population. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2070.
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To identify reasons for poor longitudinal glaucoma follow-up and investigate ethnic disparities in barriers to follow-up among glaucoma patients at San Francisco General Hospital.
This 1-to-1, matched, case-control study enrolled 130 subjects with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year as found in the medical records. We collected data by oral questionnaire on patient ethnicity and "significant barriers" faced in attending glaucoma follow-up exams.
Subjects altogether reported a total of 380 significant barriers for a mean of 2.9 barriers per subject. The most prevalent barrier reported was long waiting times in clinic (80.8%), with patients reporting mean wait times of 2.5 hours (SD 1.4 hours). The following were cited as the most important barriers to follow-up: long waiting times in clinic (23.8%), other medical or physical conditions (12.3%), and additional waiting times and difficulties associated with obtaining language interpreters (10.0%). Interestingly, excluding long waiting times, Caucasian and Asian/Pacific Islander patients both reported "other medical or physical conditions" as their next most important barrier to follow-up (20% and 19%), particularly orthopedic and mobility issues. Meanwhile, Latino subjects viewed additional waiting times and difficulties associated with interpreters (26%) as their most significant barrier, while Black patients disproportionately faced barriers related to appointment scheduling and work responsibilities (25%). Finances and lack of awareness regarding the importance of follow-up were only rarely mentioned as a barrier.
In medically underserved patient populations, health care providers may attribute poor follow-up among glaucoma patients to financial, socio-economic, and cultural challenges faced by many patients. However, upon systematic investigation, patients viewed organizational aspects of the health care delivery system, such as long waiting times, inconveniences related to obtaining interpreters, and scheduling difficulties, as their most significant barriers to attending follow-up appointments. Certain barriers to follow-up also disproportionately affect particular ethnic groups. Strategies to improve glaucoma follow-up should focus on making structural improvements to the health care delivery system and considering patient- and ethnicity-specific barriers to follow-up.
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