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Y. Murakami, B. W. Lee, M. T. Duncan, A. A. Kao, J.-Y. Huang, S. Lin, K. Singh; Risk Factors for Poor Follow-Up Among Patients With Glaucoma in a County Hospital Population. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5832.
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To identify factors associated with poor follow-up among glaucoma patients at San Francisco General Hospital.
This 1-to-1, matched, case-control study enrolled 130 patients with established glaucoma. Cases (poor follow-up) and controls (good follow-up) were determined based on the number of and maximum intervals between follow-up glaucoma exams (FGEs) attended in the preceding year as found in patient medical records. Data regarding various predictors of follow-up compliance were collected by oral questionnaire.
Factors that independently predicted poor FGE attendance included: lack of English fluency (Adj. OR 7.11, 1.37-36.83), having symptomatic glaucoma upon initial diagnosis (Adj. OR 10.42, 1.89-57.65), not knowing that glaucoma causes optic nerve damage (Adj. OR 8.62, 2.39-13.43), and lack of glaucoma education from pamphlets/posters (Adj. OR 6.76, 1.53-15.04) and from family/friends (Adj. OR 4.91, 1.12-29.32). Notable factors not significantly associated with FGE attendance included race/ethnicity, education level, and disease severity.
Patients lacking English fluency and with less knowledge and education about glaucoma are significantly more likely to have poor longitudinal follow-up for their glaucoma. Patients with symptomatic glaucoma at the time of diagnosis were also more likely to have poor glaucoma follow-up. Meanwhile, other factors traditionally believed to influence follow-up, such as race/ethnicity, education level, and disease severity, were not significantly associated with poor follow-up upon multivariate logistic regression. These findings suggest that improving patient knowledge about the effects of glaucoma and providing supplementary sources of information on disease may improve longitudinal follow-up for glaucoma. Moreover, patients lacking English fluency or with symptomatic glaucoma on initial diagnosis should receive individualized counseling and education in order to minimize disparities in glaucoma management in underserved populations.
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