Abstract
Purpose :
To examine follow-up rates and barriers to care for patients referred from a free ophthalmology homeless clinic.
Methods :
This retrospective cohort included 68 patients who were evaluated at a free, monthly ophthalmology clinic from September 2017 to 2018 at a local homeless shelter. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a partnering nonprofit organization. Follow-up rates were calculated. Categorical variables were compared with chi-squared testing to determine their association with follow-up rates.
Results :
Of the 68 patients, 40 (59%) were referred to a partnering nonprofit organization for free eyeglasses and 17 (25%) were referred to a local county hospital for advanced ophthalmologic care. Of those referred, 7 patients (41%) presented to their county hospital appointment while 14 patients (35%) presented to the nonprofit organization for free eyeglasses. Fifty-two percent of patients with a pre-established primary care provider (PCP) presented to their referral appointment while only 20% of patients without a PCP presented to their appointment (p = 0.025). Nineteen of the 43 patients (44%) who completed at least a high school education presented to their referral appointment while all patients without a high school diploma failed to present to their appointment (p = 0.037). Vision-threatening conditions identified at the homeless clinic did not significantly affect follow-up rates: patients with diabetic and hypertensive retinopathy, afferent pupillary defects, glaucoma/glaucoma suspect, and visual field defects were not more likely to present to their referral appointment at the county hospital compared to those without vision-threatening conditions (p = 0.79).
Conclusions :
In the current literature, there is limited knowledge of follow-up rates for ophthalmologic diseases and refractive error among those without permanent housing. In our study, less than half of referred patients presented to their appointments. Barriers to presentation included no PCP and lower educational status. There was no improvement in follow-up rates among those being referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be beneficial, particularly in those not looped into the healthcare system and those of lower educational attainment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.