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Andrew Zolot, Nathalie Abenoza, Judy E Kim, Velinka Medic, Kayla Davis, Jay Romant, Al Castro, Mirtha Sosa Pachero; Barriers to Follow-Up Care in an Underserved Community-Based Tele-Ophthalmology Screening Program. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1087.
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Studies have shown the effectiveness of tele-ophthalmology in early detection of diabetic retinopathy (DR) in those at risk, but there has been minimal research regarding the success of follow-up care once DR or other abnormalities have been detected. We aimed to assess adherence and barriers to recommended diabetic eye care follow-up and the issues encountered by case managers in a community based DR screening program.
The Tele-Eye Health Collaborative is a partnership between the Milwaukee Health Department (MHD), United Community Center (UCC), The Medical College of Wisconsin (MCW), and local institutions that brings retinal screenings to community organizations and events through the use of a mobile non-mydriatic fundus camera (Eidon). Trained community members and MHD nurses provided free screenings for 1107 participants (~42% African American, 31% Latino) with and without diabetes during an eighteen-month period. Images were analyzed for retinopathy findings and results were mailed to all participants. Those with urgent abnormal findings received phone calls from MHD nurses or Spanish-fluent UCC staff members to coordinate care. Call logs were reviewed to identify follow-up status, required interventions, and barriers to establishing recommended care by participants and case managers.
Seventy-six participants were identified to have ocular findings severe enough to require follow-up care within three months. Among those successfully contacted, barriers cited included lack of insurance (32%), language barriers for non-English speakers (30%), overwhelming health issues (7%), and difficulty scheduling ophthalmology appointments. Thirty (40%) of these participants were documented as having seen an eye care specialist, and many others saw their PCP for diabetes management. Case managers called 62 (82%) of these participants more than once, but 19 were never reached via phone despite multiple attempts.
Cultural sensitivity, personalized education, and extensive case management are needed to bridge the gap between recommendations and real-world actions. Even with coordination, only 40% of participants had seen an eye care specialist within three months. Barriers such as insurance, language, and education need to be addressed in a societal manner if we strive to be successful in increasing adherence to follow-up care recommendations.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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