Abstract
Purpose :
To evaluate the adherence to recommended follow-up for pediatric ophthalmology patients before and after the onset of the COVID-19 pandemic, and to identify characteristics associated with low follow-up adherence.
Methods :
Retrospective review of new patients seen in the pediatric ophthalmology clinic using data from one month per quarter in both 2019 and 2021 (total 8 months). We compared ophthalmologist recommended follow-up interval to actual follow-up interval and patients were categorized as adherent (followed up within 0-30 days of recommended), nonadherent (31-180 days), or lost to follow-up (later than 180 days of recommended or no follow-up visit). Multinomial logistic regression analysis assessed variables associated with adherence category including demographics, insurance, and distance to provider reported as odds ratio (OR) and 95% confidence intervals (CI).
Results :
476 of 781 patients were included in the final analysis (excluding 305 patients recommended to follow-up as needed or who had a future follow-up date). 44% were female and average age was 5.1 years at first visit. The percentage of adherent patients was 47% in 2019 and 49% in 2021. The percentage of nonadherent patients was 11% (2019) and 9% (2021). Patients with public (versus private) insurance were more likely to be lost to follow-up in both 2019 and 2021 (OR 1.75, 95% CI 1.07-2.88, p=0.03). Compared with patients being followed for congenital ocular abnormalities, those followed only for refractive error were more likely to be lost to follow-up (OR 5.12, 95% CI 2.18-12.06, p=0.0001). No significant differences in follow-up adherence were identified before or after the pandemic when comparing patient self-reported race, language, age, or distance to provider (Table 1).
Conclusions :
Nearly half of pediatric ophthalmology patients were nonadherent or lost to follow-up, which was unchanged by the COVID-19 pandemic. Ophthalmologists should consider public insurance status as a barrier to follow-up adherence. Increasing engagement with patients with public insurance, such as consultation with a social worker, may be beneficial to improve follow-up adherence rates.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.