Abstract
Purpose :
Regular ophthalmology follow-up is essential for patients with diabetic retinopathy (DR), the leading cause of vision loss in working-age people in the US. Research is needed to better understand factors influencing follow-up and to find ways to encourage appropriate attendance. We sought to delineate patient-perceived barriers to ophthalmic follow-up in our mostly rural population. We anticipated patients with poor follow-up would report more barriers, and financial barriers related to transportation, parking, and childcare would be prominent.
Methods :
Semi-structured interviews were conducted with adult patients with diabetes mellitus seen at least once in our clinics for diabetic eye care. Participants were randomly selected from a previous retrospective study based on whether they had good (n=10) or poor (n=10) attendance at follow-up appointments. Questions explored factors that supported or prevented their attainment of the prescribed interval, the management and progression of their diabetes, and their knowledge about DR. Results between the two groups were compared with descriptive statistics.
Results :
Both groups of patients reported similar barriers to attendance, and 85% of patients reported at least 1 barrier. The most stated barriers for both groups were financial cost, having someone accompany them, and parking. The poor follow-up group also reported taking time off work as a barrier. More patients in the good follow-up group reported regularly checking their blood sugar (90% vs. 70%) and following up with their primary care physician (100% vs. 90%). They also responded more accurately to 3 knowledge questions about DR (77% vs. 57% correct responses).
Conclusions :
The interviews challenged the notion that our patients with poor follow-up faced more barriers than those with good follow-up. When patients with good follow-up were asked an open-ended question of what factors allowed them to make it to their appointments, 50% of them responded by describing barriers instead; demonstrating how these patients also overcame challenges. Patients expressed a wide variety of factors that affected their ability to attend appointments, so any specific incentive, such as a parking voucher, ride service, or scheduling assistance may not meet the needs of all patients. It may be more effective to offer a financial incentive to utilize tools of behavioral economics to encourage patients to attend follow-up visits.
This is a 2021 ARVO Annual Meeting abstract.