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S. Parthasarathi, B. W. Lee, K. Singh, R. K. John, A. L. Robin; Factors Associated With Poor Follow-Up Among Glaucoma Patients in South India. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4349.
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To determine the factors associated with poor follow-up among glaucoma patients in South India.
This prospective case-control study enrolled 300 established patients with primary glaucoma, including 150 who did and 150 who did not attend follow-up glaucoma examinations (FGEs) as advised in the past year at Aravind Eye Hospital. Responses regarding various factors hypothesized to be associated with follow-up compliance were collected by oral questionnaire.
The factors most associated with poor FGE attendance included: means-tested waiving of clinic fees for low-income patients [Adj. OR--3.10, 0.91-10.50], lower perceived importance of attending FGEs [Adj. OR--10.80, 4.40-26.50], and non-use of glaucoma medications [Adj. OR--2.10, 1.10-4.00]. Notable factors not significantly associated with FGE attendance included: severity of disease, convenience of travel, direct and indirect costs associated with attending FGEs, and self-reported difficulty attending FGEs.
Despite the waiving of clinic fees, low-income status is still associated with poor follow-up. Many factors traditionally believed to influence follow-up, such as travel to clinic and severity of disease, were found to have little to no effect in this study. This research suggests that efforts to improve patient attendance of FGEs should focus on improving patients' knowledge and perceptions about the importance of attending regular FGEs, since even marginal differences in patients' perceived importance of follow-up ("somewhat important" vs. "very important") were associated with significant differences in FGE attendance. Administering short questionnaires that elicit factors associated with poor follow-up may be a valuable means of identifying patients at greater risk for poor follow-up. These patients can then be counseled, educated, and treated appropriately in order to minimize disease progression and unnecessary glaucoma-induced vision loss.
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