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Di Zhao, Eliseo Guallar, Bonnielin K Swenor, Prateek Gajwani, Lucy Mude, David S Friedman; Compliance and barriers for follow-up care in community eye screening: the SToP Glaucoma Study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2586.
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© ARVO (1962-2015); The Authors (2016-present)
To identify barriers to follow-up eye care in individuals aged 50 years and older with abnormal findings in a community-based glaucoma screening.
Individuals screened at community sites in Baltimore, MD with abnormal findings were referred at no cost for a definitive exam at the Wilmer Eye Institute. Those who failed to show for their scheduled visit were called a minimum of 3 times and offered other appointments. Those who did not schedule or did not show after 5 reschedule attempts were classified as “lost to follow-up”; participants yet to come in for visits were classified as having “incomplete” visits. Multivariable logistic regression models were used to assess the association between demographic, behavioral, and ocular risk factors and loss to follow-up.
Among 419 individuals referred for an eye exam, 202 (48.2%) completed their visits and 106 (25.3%) were lost to follow-up (Table 1) The odds ratio (OR [95% CI]) for loss to follow-up was 5.82 (2.66, 12.76) comparing those referred for refraction only vs those referred for eye abnormalities, 0.54 (0.29, 0.98) for those with high school vs <high school education, 0.47 (0.24, 0.92) for those with presenting visual acuity (PVA) 20/50-20/200 vs 20/40 in the better eye, 3.50 (1.75, 7.00) for participants with ungradable/untestable vs gradable/testable results on autorefraction or fundus imaging, and 2.04 (1.03, 4.05) for screening sites of 1-<3 vs <1 mile from the hospital (Table 2). Insurance status and self-reported difficulty in walking were not significantly associated with loss to follow-up. A negative association between older age and loss to follow-up was observed in model 1 but was attenuated and no longer significant in the fully adjusted model (Model 3, Table 2).
Identified risk factors for not following-up after eye screening were: low education, poor PVA, longer distance from screening sites to hospital, referral for refraction only, untestable/ungradable autorefraction or fundus photos, and younger age. Many with poor vision requiring refraction who were offered free glasses did not attend the definitive exam. While this program removes some cost-associated barriers, transportation and other opportunity costs may still play a role. Efforts are being made to improve follow-up rates using various strategies.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Characteristics of participants.
Odds ratio for loss to follow-up associated with risk factors.
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