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B. W. Lee, S. Parthasarathi, K. Singh, R. K. John, A. L. Robin; Self-Reported Barriers and Strategies to Better Follow-Up Among Glaucoma Patients in South India. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4336.
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To identify barriers against and develop strategies to improve attendance of follow-up glaucoma examinations (FGEs) in South India.
A prospective case-control study enrolled 300 established patients with primary glaucoma, including 150 who did and 150 who did not attend FGEs as advised in the past year at Aravind Eye Hospital. A medical record review was performed and identified 226 (75.3%) patients who failed to attend at least one FGE over the past year. These patients were asked to identify the cause(s) of non-attendance. All 300 patients were asked about various strategies to facilitate FGE attendance.
Among the 226, 43.8% reported "My eyes were okay" as a reason for not attending follow-up. The following were cited as the most important reason for non-attendance: "My eyes were okay" (25.7%), "Lack of Escort" (15.0%), and "Unable to leave work responsibilities" (7.5%). Providing a mobile glaucoma van (64.0%) or satellite vision station (44.3%) at which ocular examinations could be performed were identified as the best strategies to facilitate FGE attendance, followed by providing reminders a week before appointment dates (33.0%).
Widespread lack of awareness on the importance and rationale for attending FGEs is still the most important reason why patients fail to attend FGEs, whereas medical fees, lost wages, and transportation difficulties appear to be far less important factors. Strategies to improve attendance of FGEs should focus on providing more effective patient education and counseling on the importance of FGEs in managing glaucoma and reducing vision loss. Since patients themselves favor strategies that would decrease transportation time and overall time required to attend FGEs, various adjunctive strategies that would help in rescheduling missed appointments, decreasing patient waiting time, or facilitating follow-up through novel means should not be overlooked.
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