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Shan C. Lin, Yohko Murakami, Bradford W. Lee, Martin Duncan, Andrew Kao, Jehn-Yu Huang, Kuldev Singh; Increased Risk of Noncompliance with Medication Use and Follow-up Exams in Glaucoma Patients in a County Hospital Population. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5040.
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To identify glaucoma patients at particularly high risk for poor disease outcomes in a county hospital population at the San Francisco General Hospital.
Prospective recruitment of 152 individuals with established glaucoma, with 1-to-1 matching of cases (subjects with poor follow-up) and controls (subjects with good follow-up). Data regarding ethnicity and barriers to follow-up was collected by oral questionnaire.
Individuals of Latino ethnicity with limited English proficiency and individuals of black race with a family history of glaucoma were at greatest risk for poor follow-up and noncompliance with medications (adjusted OR 8.38, 95% CI 3.39-12.31 and 7.21, 95% CI 2.16-15.47, respectively). The most prevalent reasons reported for noncompliance with medications was a subjective perception of stable vision between follow-up exams without adverse symptoms (62%) and unfamiliarity of treatment duration (39%) and the permanency of glaucomatous vision loss (32%). Of the black patients with poor follow-up and/or poor compliance with medications, 73.5% reported a family history of glaucoma. Good follow-up was associated with no reported knowledge regarding glaucoma from family and friends (adjusted OR 0.24, 95% CI 0.07-0.91). Notable factors not significantly associated with follow-up patterns and medication compliance were travel time to clinic and cost of medications, respectively.
Given that Latinos with limited English proficiency and blacks with a family history of glaucoma are significantly more likely to have poor longitudinal follow-up and medication compliance for their glaucoma, we recommend targeted interventions for these populations in order to minimize disparities in disease outcomes in underserved populations. Strategies to improve glaucoma follow-up and medication compliance should focus on patient-and ethnicity-specific education and counseling.
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