Healthcare access and utilization barriers to ophthalmic visits among patients with glaucoma: an All of Us study

Abstract

Purpose : To characterize healthcare access and utilization barriers for ophthalmic visits among patients with glaucoma.

Methods : This cross-sectional study included adult glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey. Completion of ophthalmic visits (visit adherence) was defined by answers about past-year encounters with eyecare providers. Participants were categorized into “visit” and “non-visit” groups. We extracted data from survey items regarding potential barriers to ophthalmic visits, including past-year medical visits, inabilities to afford healthcare, and self-reported reasons for delayed care. Chi-Square tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) for variables associated with visit adherence were calculated in univariable and multivariable models.

Results : Of 5739 glaucoma patients, 861(15%) had not seen an eyecare provider in the past year. More participants in the visit group reported seeing a general doctor or specialist in the prior year (94%/65%), as compared to the non-visit group (89%/49.3%; P<0.05). The non-visit group reported greater difficulty in affording medical care and learning about medical conditions, and also higher rates of delayed or missed healthcare access for various concerns (P<0.05). In the multivariable model, factors associated with visit adherence included older age (OR[95%CI]=1.02[1.01, 1.03]), higher education (OR=1.25[1.13, 1.40]) and income level (OR=1.06[1.01, 1.11]), not employed for wages (OR=1.28[1.08, 1.53]), and overall higher healthcare utilization in general medical/other specialist visits (ORs ranging from 1.08-1.90) (Table 1; P<0.05). Worse visit adherence was associated with reporting taking less medication to save money (OR=0.62[0.40, 0.97]) and delaying/avoiding seeing healthcare providers because of dissimilarity (OR=0.84[0.71, 0.99]; P<0.05).

Conclusions : Lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with healthcare providers were risk factors for under-utilization of eyecare by glaucoma patients in this nationwide cohort. These results provide insights into strategies to improve real-world visit adherence, and also identify glaucoma patients who might benefit from outreach or additional counseling.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.