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Yu G, Michalak S, Mishra K, Yu M, Pan C. Trends of Ophthalmic Surgery Cancellations at a County Hospital Before and During COVID-19: A 10-Year Retrospective Study. Semin Ophthalmol 2024; 39:305-311. [PMID: 38073109 DOI: 10.1080/08820538.2023.2293032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Despite several publications on ophthalmic surgical cancellations discussing preventative causes in academic institutions, there remains a paucity of similar studies for safety-net hospitals. This study analyzed cancellation rates at a county hospital over a 10-year period. METHODS This retrospective, open cohort study investigated a total of 11,350 surgeries scheduled at a tertiary-level county hospital between January 1, 2012 and December 31, 2021. Surgical cancellation reasons were collected from chart review and categorized into eight groups to allow for analyses. Cancellation rates were then calculated per year and per subspecialty. The primary statistical analyses were paired, 2-tailed t test and χ2 test. RESULTS The most common reason for cancellation overall was institution-related (1065 surgeries), which was also the most common reason per year from 2012 to 2019 (range: 37.4% - 60.6%). In 2020, during COVID-19 stay-at-home mandates, the most common reason became COVID-related rescheduling, and in 2021, it was patient-driven. The cancellation rate in 2020 was significantly higher than 2019 (+9.27%,95% CI:4.96%-13.6%,p = .05), and significantly lower from 2021 to 2020 (-22.8%,95% CI:-26.8%-(-)18.7%,p = .001). Pediatric surgery had the highest cancellation rate overall (36.4%), but oculoplastics had the highest cancellation rate in 2020 (48.9%). CONCLUSION The most common reason for cancellation over the 10-year period was institution-related, in contrast to other publications based in academic centers. The study also had a higher cancellation rate than previously reported, again suggesting the difference between county and academic centers. The COVID-19 pandemic had a significant impact on cancellations, even after the COVID-19 stay-at-home orders were eased.
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Affiliation(s)
- Gina Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Suzanne Michalak
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Kapil Mishra
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Michael Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Carolyn Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
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Lin H, Lu HJ, Zhou WZ, Zuo SS, Chen YY, Zhang SD. Patient satisfaction and follow-up adherence to glaucoma case management clinic in China. Int J Ophthalmol 2024; 17:73-81. [PMID: 38239960 PMCID: PMC10754673 DOI: 10.18240/ijo.2024.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/21/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes. METHODS In this cross-sectional study, a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire. Clinical data was obtained from the case management system. Follow-up adherence was defined as completing each follow-up within ±30d of the scheduled time set by ophthalmologists during the study period. RESULTS Average satisfaction scored 78.65±7, with an average of 4.39±0.58 across the seven dimensions. Age negatively correlated with satisfaction (P=0.008), whilst patients with follow-up duration of 2 or more years reported higher satisfaction (P=0.045). Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence (OR=0.97, 95%CI, 0.95-1.00, P=0.044). Additionally, patients with suspected glaucoma (OR=2.72, 95%CI, 1.03-7.20, P=0.044) and those with an annual income over 100 000 Chinese yuan demonstrated higher adherence (OR=5.57, 95%CI, 1.00-30.89, P=0.049). CONCLUSION The case management model proves effective for glaucoma patients, with positive adherence rates. The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
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Affiliation(s)
- Hao Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Hu-Jie Lu
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wen-Zhe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shu-Shu Zuo
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yan-Yan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Shao-Dan Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Sharma A, Roh S, Ramsey DJ. Targeted Telephone-Based Outreach Reconnects Glaucoma Patients With Subspecialty Care. J Glaucoma 2024; 33:28-34. [PMID: 37327477 DOI: 10.1097/ijg.0000000000002256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
PRCIS A personalized telephone-based intervention is a cost-effective method to return overdue patients with open angle glaucoma (OAG) to subspecialty care. Patients who accepted care overwhelmingly preferred in-person appointments with their provider instead of hybrid visits with telehealth. PURPOSE To evaluate the effectiveness of a telephone-based outreach strategy to reconnect OAG patients with subspeciality care. PATIENTS AND METHODS Established patients with OAG who were seen before March 1, 2021, but had not returned for care in the following year were contacted via a telephone-based intervention. Patients lost to follow-up (LTF) were offered the option of an in-person visit or a hybrid telehealth visit, which combined in-office testing of vision, intraocular pressure, and optic nerve imaging with a virtual consultation with their glaucoma specialist on a separate date. RESULTS Of 2727 patients with OAG, 351 (13%) had not returned for recommended care. Outbound calls reached 176 of those patients (50%). Nearly half of all patients contacted readily accepted care, with 71 scheduling in-person appointments (93%) and 5 selecting hybrid visits (6.6%). Medication refills were requested by 17 of those 76 patients, representing nearly a third of the 56 patients who were treated with topical glaucoma medications. Assessment of the program 90 days later found that 40 patients had returned for care, 100 patients had transferred or declined further care, and 40 patients were identified as deceased, lowering the LTF rate to 6.4%, with 15 patients still scheduled for future visits. On the basis of an average call duration of 2.8±2.0 minutes, the added cost of returning a patient with OAG to care by the program was $28.11. CONCLUSIONS Providing targeted outreach by telephone is an effective and cost-efficient strategy to reconnect OAG patients LTF with subspecialty care.
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Affiliation(s)
- Arjun Sharma
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
| | - Shiyoung Roh
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
| | - David J Ramsey
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
- Division of Ophthalmology, Lahey Hospital & Medical Center, Peabody, MA
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DeYoung C, Asahi MG, Rosenberg S, Pakhchanian H, Liu IZ, Bellur S, Raiker R, Dalal M. Ophthalmology procedure trends in the United States during the COVID-19 pandemic. Int Ophthalmol 2023; 43:4651-4668. [PMID: 37709910 DOI: 10.1007/s10792-023-02865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/20/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To evaluate the relationship between the COVID-19 pandemic and ophthalmic procedural volume. METHODS A retrospective cohort study using TriNetX, a federated electronic health record's research network was done. Monthly Current Procedural Terminology-specific volumes per healthcare organization were clustered chronologically to calculate average volumes into 3-month seasons to calculate average procedural volumes. An aggregate of the total pandemic period (March 2020-August 2021) was compared to corresponding figures in pre-pandemic timeframes. RESULTS Intravitreal injections were the most prevalent procedure in this time period with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure. From March 2020 to August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p < 0.05) in procedures compared to the pre-pandemic mean of 280.8 (SD = 26.1). Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (- 88%). The largest count of statistically significant increases in procedure volume was in Spring 2021 (+ 18%). The aggregate mean volume per HCO showed significant decreases for 11 out of 17 procedures in the 12 month March 2020-February 2021 timeframe and significant decreases for 10 out of 17 procedures over the 18-month March 2020-August 2021 pandemic period. CONCLUSIONS This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in America. Quantifying ophthalmic procedure trends is important in retrospectively assessing surgical disruptions and prospectively accommodating delayed surgeries. Furthermore, awareness of these trends could help ophthalmologists prepare should similar disruptions occur in the setting of future pandemics or national disasters.
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Affiliation(s)
- Charles DeYoung
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St. #100, Philadelphia, PA, 19107, USA.
| | - Masumi G Asahi
- Department of Ophthalmology, George Washington University, Washington, DC, USA
| | - Sedona Rosenberg
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Haig Pakhchanian
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ivan Z Liu
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sunil Bellur
- Department of Ophthalmology, George Washington University, Washington, DC, USA
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rahul Raiker
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Monica Dalal
- Department of Ophthalmology, George Washington University, Washington, DC, USA
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Chang PY, Wang YH, Wang JY, Wang JK. Adherence to visual field examination in glaucoma patients during the Coronavirus disease 2019 outbreak. Medicine (Baltimore) 2023; 102:e35314. [PMID: 37800774 PMCID: PMC10553118 DOI: 10.1097/md.0000000000035314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
We described the proportion of adherence to the scheduled visual field (VF) examination and the associated factors in glaucoma patients in a tertiary referral center during the Coronavirus disease 2019 (COVID-19) outbreak in Taiwan. Patients with scheduled VF examinations during May 25th to July 12th, 2021, were retrospectively evaluated. Clinical characteristics including type of glaucoma, intraocular pressure (IOP) at the day of arranging VF examinations, prescriptions of anti-glaucoma medications, non-medical glaucoma treatment, length of glaucoma history, mean deviation (MD) of VF defect, and announcement of glaucoma progression were recorded. The associations between the adherence and the clinical factors were analyzed by univariate and multivariate logistic regression. There were 204 patients included, of which 37 patients (18.14%) adhered to VF examinations. A total of 161 patients (78.9%) were diagnosed with open-angle glaucoma (OAG), 27 patients (13.2%) with angle closure glaucoma, and 16 patients (7.8%) with glaucoma suspect. Most of the participants (41.2%) had mild VF defect and had been prescribed with no more than 1 bottle of anti-glaucoma medication. In the multivariate analysis, diagnosis of glaucoma suspect (P = .02) and history of SLT (P = .04) were significantly associated with better adherence. Glaucoma severity and the announcement of glaucoma progression were not significantly associated with adherence to VF examination. The COVID-19 pandemic had greatly influenced the adherence to VF examination in glaucoma patients. This study demonstrated that patients with the diagnosis of glaucoma suspect and history of SLT were more likely to adhere to VF examinations even during the COVID-19 pandemic.
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Affiliation(s)
- Pei-Yao Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, New Taipei City, Taiwan
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, Republic of China
- Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Yu-Han Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, New Taipei City, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, Republic of China
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, New Taipei City, Taiwan
- Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
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Scanzera AC, Sherrod RM, Potharazu AV, Nguyen D, Beversluis C, Karnik NS, Chan RVP, Kim SJ, Krishnan JA, Musick H. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol 2023; 12:11. [PMID: 37831446 PMCID: PMC10587857 DOI: 10.1167/tvst.12.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose To explore barriers and facilitators to completing scheduled outpatient appointments at an urban academic hospital-based ophthalmology department. Methods Potential participants were stratified by neighborhood Social Vulnerability Index (SVI) (range, 0-1.0, higher scores indicate greater vulnerability), and semistructured interviews were conducted with individuals 18 years and older with an SVI of greater than 0.61 (n = 17) and providers delivering care in the General Eye Clinic of the University of Illinois Chicago (n = 8). Qualitative analysis informed by human-centered design methods was conducted to classify barriers and facilitators into three domains of the Consolidated Framework for Implementation Research: outer setting, inner setting, and characteristics of individuals. Results There were four main themes-transportation, time burden, social support, and economic situation-all of which were within the outer setting of the Consolidated Framework for Implementation Research; transportation was most salient. Although providers perceived health literacy as a barrier affecting motivation, patients expressed a high motivation to attend visits and felt well-educated about their condition. Conclusions A lack of resources outside of the health system presents significant barriers for patients from neighborhoods with high SVI. Future efforts to improve adherence should focus on resource-related interventions in the outer setting. Improving access to eye care will require community-level interventions, particularly transportation. Translational Relevance Understanding the barriers and facilitators within the Consolidated Framework for Implementation Research provides useful guidance for future interventions, specifically to focus future efforts to improve adherence on resource-related interventions.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - R. McKinley Sherrod
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Diana Nguyen
- Institute of Design, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Niranjan S. Karnik
- Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robison V. P. Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sage J. Kim
- Division of Health Policy, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
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Hou CH, Shih SF, Pu C. Adherence of those With Self-Reported Glaucoma in the United States to Eye Examination Visits. J Glaucoma 2023; 32:885-890. [PMID: 36971614 DOI: 10.1097/ijg.0000000000002213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023]
Abstract
PRCIS The adherence of American patients with self-reported glaucoma to the follow-up recommendations is extremely low. Estimated adherence rate is lower than that obtained by previous studies that did not use a US nationally representative sample. PURPOSE To evaluate adherence to ophthalmic outpatient follow-up visits and vision examinations in the American population aged 40 years or above. METHODS The percentage of American patients aged≥40 years who adhered to glaucoma treatment guidelines was estimated using 2015-2019 Medical Expenditure Panel Survey (MEPS) data. Adherence was defined according to the International Council of Ophthalmology guidelines. We also compared individuals with and without self-reported glaucoma who have made at least one ophthalmic outpatient visit and at least 1 vision examination visit within a year. Differences in means and percentages were estimated to account for the covariance due to the complex sampling design. RESULTS Approximately 4.4 million people aged or above 40 years had self-reported glaucoma in 2019 (3.21%). The rate of prevalence significantly differed with race, with Black people having the highest prevalence in all studied years. Only 7.1% (95% CI: 0.049-0.102) and 2.67% (95% CI: 0.0137-0.0519) of this population underwent at least 1 ophthalmic outpatient examination or 1 vision examination per year. Older age, never married status, higher education, eye conditions, and diabetes were significantly associated with a higher probability of ophthalmic health care use. CONCLUSIONS Adherence to follow-up among patients with self-reported glaucoma in this population-level study was lower than that in previously reported American, non-nationally representative studies. Barriers to adherence at the population level should be assessed to inform the design of future policy or program interventions.
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Affiliation(s)
- Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University
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Da J, Gillings M, Kamat S, Nathan N. Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study. J Curr Glaucoma Pract 2023; 17:134-140. [PMID: 37920373 PMCID: PMC10618606 DOI: 10.5005/jp-journals-10078-1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023] Open
Abstract
Aims and background As the use of minimally invasive or microinvasive glaucoma surgery (MIGS) continues to expand, it is important to look at its outcomes in the hands of trainees. This study aims to examine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy and endocyclophotocoagulation (ECP) with cataract extraction (CE) done by residents and fellows. Methods All cases of KDB or ECP performed with CE between 2012 and 2020 at Parkland were reviewed, excluding cases with multiple MIGS procedures or other procedures. Results A total of 153 eyes of 136 patients who underwent KDB and 125 eyes of 124 patients who underwent ECP were included. Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (p = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (p < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (p = 0.43 and p = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively. Conclusion Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious. Clinical significance Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. IOP and medication reduction of MIGS/CE in the hands of trainees were overall lesser than reported values by attending surgeons. How to cite this article Da J, Gillings M, Kamat S, et al. Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study. J Curr Glaucoma Pract 2023;17(3):134-140.
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Affiliation(s)
- Joseph Da
- Department of Ophthalmology, UT Southwestern Medical Center (UTSW), University of Texas, Dallas, Texas, United States of America
| | - Matthew Gillings
- Department of Ophthalmology, UT Southwestern Medical Center (UTSW), University of Texas, Dallas, Texas, United States of America
| | - Shivani Kamat
- Department of Ophthalmology, UT Southwestern Medical Center (UTSW), University of Texas, Dallas, Texas, United States of America
| | - Niraj Nathan
- Department of Ophthalmology, UT Southwestern Medical Center (UTSW), University of Texas, Dallas, Texas, United States of America
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Kim AB, Cheng BT, Tanna AP. Delayed Medical Care Due to Lack of Transportation among US Adults with Glaucoma. Ophthalmol Glaucoma 2023; 6:439-441. [PMID: 36990434 DOI: 10.1016/j.ogla.2023.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Anne B Kim
- Rush University Medical College, Chicago, Illinois
| | - Brian T Cheng
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Angelo P Tanna
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Hicks PM, Kang L, Armstrong ML, Pongrac JR, Stagg BC, Saylor KM, Newman-Casey PA, Woodward MA. A scoping review of patients' barriers to eye care for glaucoma and keratitis. Surv Ophthalmol 2023; 68:567-577. [PMID: 37004793 PMCID: PMC10875963 DOI: 10.1016/j.survophthal.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
In this scoping review, we examine underlying causes of loss to follow-up for chronic (glaucoma) and acute (corneal ulcers) eye conditions using the Penchansky and Thomas access to care framework. We explore barriers by World Health Organization income levels and by studying geographical location. We identified 6,363 abstracts, with 75 articles retrieved and 16 meeting inclusion criteria. One article discussed barriers to follow-up care for people with corneal ulcers, and the other 15 were for people with glaucoma. The most frequent barriers to care were affordability, awareness, and accessibility. The international studies had a greater percentage of studies report acceptability as a barrier to loss to follow-up. Countries with universal healthcare included affordability as a loss to follow-up barrier, emphasizing that cost goes beyond the ability to pay for direct treatment costs. Understanding and addressing barriers to follow-up care can aid the goal of continued care and decrease the risk of poor outcomes and vision loss.
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Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - Joseph R Pongrac
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Brian C Stagg
- John Moran Eye Center, University of Utah, Salt Lake City, UT, USA; Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Kate M Saylor
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Droste AP, Newman-Casey PA. Emerging glaucoma treatments: are we seeing an improvement in adherence? EXPERT REVIEW OF OPHTHALMOLOGY 2023; 18:101-111. [PMID: 37520660 PMCID: PMC10373909 DOI: 10.1080/17469899.2023.2199981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/03/2023] [Indexed: 08/01/2023]
Abstract
Introduction Non-adherence to glaucoma medication and poor follow-up is a global health concern. Areas covered Glaucoma remains one of the largest causes of irreversible blindness worldwide. Traditional treatment guidelines suggest topical eye drop medication as first line therapy followed by addition of supplementary medications before proceeding to more invasive glaucoma surgeries. Unfortunately, poor glaucoma self-management remains high, leading to disease progression and blindness. Recent advancements in the field of pharmacotherapies, surgeries, and behavioral approaches have taken aim at increasing support for glaucoma self-management. We review the current and emerging approaches towards glaucoma management, with the exception of bleb-based surgical approaches, to investigate if they have had an impact on adherence. Literature searches were conducted via MEDLINE (PubMed), Embase (Elsevier), Cochrane Library (Wiley), and Preprints from January 1st, 2018, to January 26th, 2023. Expert opinion The ability to offer patients a multitude of choices enables patients to tailor their glaucoma treatment to their values and lifestyle. Offering personalized patient education and coaching to support chronic glaucoma self-management would better enable patient engagement in whichever treatment path is chosen. Currently, literature regarding the impact of these new advancements on treatment engagement is lacking; this field is ripe for additional intervention and assessment.
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Affiliation(s)
- Andrew P Droste
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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12
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Zhao QF, Hirneiss C. Does Diabetes Influence Adherence in Glaucoma Patients? Klin Monbl Augenheilkd 2023; 240:136-141. [PMID: 36351553 DOI: 10.1055/a-1975-2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With chronic diseases, patient adherence plays a crucial role in delaying disease progression and in determining the success of therapy. Problems arise not only from low medication adherence, but also non-adherence to recommended follow-up examinations. Obtaining an accurate estimate of adherence is difficult, especially in glaucoma patients, due to the fact that most antihypertensive drugs are administered in the form of eye drops. There is great variability in the published adherence values for glaucoma patients. Most studies report an average medication adherence of approximately 70%, with around 50% of patients having good adherence (at least 80% of medication administered as planned). Furthermore, 6.8 - 31.4% of the eye drops do not end up in the patient's eye, which means there is even less active ingredient to achieve a therapeutic effect. Glaucoma patients also show low persistence and adherence to follow-up appointments. Since diabetes increases the risk for POAG and secondary glaucoma and given that diabetics have particularly low adherence, the question arose whether a diabetes diagnosis is associated with reduced adherence in glaucoma patients. Previous studies found no significant association between diabetes and reduced adherence in glaucoma patients, although a significant impact of elevated HbA1c on adherence in glaucoma patients was found in one study. However, this connection still needs to be examined more closely in studies with larger samples.
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Affiliation(s)
- Qifan Felix Zhao
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
| | - Christoph Hirneiss
- Glaukomsprechstunde, Augenklinik und Poliklinik des Klinikums der Universität München, München, Deutschland
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13
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Fırat P, Dikci S, Can A, Türkoğlu E. Evaluation of medication adherence of glaucoma patients during the COVID-19 pandemic. J Fr Ophtalmol 2023; 46:11-18. [PMID: 36435659 PMCID: PMC9671694 DOI: 10.1016/j.jfo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate changes in the medication adherence of glaucoma patients during the COVID-19 pandemic and the factors influencing medication adherence. MATERIALS AND METHODS This cross-sectional study included a total of 197 glaucoma patients who were followed for at least six months in the Glaucoma Unit of the Ophthalmology Department of Inonu University, Faculty of Medicine. Patients were given a 28-item questionnaire, including the eight-item Morisky Medication Adherence Questionnaire, to evaluate medication adherence. Demographic and clinical data were recorded. P<0.05 was considered statistically significant. RESULTS Interruption of glaucoma clinic visits during the pandemic was reported by 82 (41.6%) patients. Nonadherence was reported by 56 patients (28.4%) (95% confidence interval: 22.1-34.7). For these patients, the most common reasons for nonadherence were forgetfulness (50%), the inability to receive a prescription for the drug (10.7%) and being busy (10.7%). Factors influencing nonadherence were determined to be younger age, female gender, interruption of glaucoma clinic visits and high-income levels (P˂0.05). CONCLUSION Interruption of glaucoma clinic visits during the COVID-19 pandemic and the resulting inability to have medications prescribed resulted in patient nonadherence with medication use.
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Affiliation(s)
- P.G. Fırat
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey
| | - S. Dikci
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey,Corresponding author
| | - A. Can
- Inonu University, Faculty of Medicine, Department of Ophthalmology, Malatya, Turkey
| | - E.B. Türkoğlu
- Akdeniz University, Faculty of Medicine, Department of Ophthalmology, Antalya, Turkey
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14
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Duong AT, Van Tassel SH. Depression and Glaucoma: A Review and Considerations for Researchers and Providers. Int Ophthalmol Clin 2022; 62:39-44. [PMID: 36170220 DOI: 10.1097/iio.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Williams AM, Schempf T, Liu PJ, Rosdahl JA. Loss to Follow up among Glaucoma Patients at a Tertiary Eye Center over 10 Years: Incidence, Risk Factors, and Clinical Outcomes. Ophthalmic Epidemiol 2022:1-9. [PMID: 36154557 DOI: 10.1080/09286586.2022.2127787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess the incidence, risk factors, and clinical consequences of loss to follow up (LTFU) among glaucoma patients at our institution over a 10-year period. METHODS This retrospective study examined LTFU among a cohort of glaucoma patients with a clinical encounter in 2010. LTFU was defined as 52 weeks or more without an encounter and without alternative reason for discontinued care, such as discharge, documented move, or death. Baseline demographic and clinical characteristics were collected and compared between LTFU and non-LTFU groups using a logistic regression model to identify risk factors for LTFU. Odds ratios (ORs) are reported with 95% confidence intervals. Clinical outcomes were documented for LTFU patients who returned after a lapse in care. RESULTS Among the 395 included patients, 132 (33%) were LTFU over the 10-year study period. Characteristics associated with LTFU in a logistic regression model included greater disease severity (OR = 1.03 [1.01-1.05], p = .023, for each worsening decibel of mean deviation) and in-state rather than out-of-state residence (OR = 2.76 [1.12-6.80], p = .027). Other potential risk factors that did not reach significance included male gender (OR = 1.39 [0.92-2.13], p = .124), Black race (OR = 1.40 [0.91-2.16] p = .123), and legal blindness (OR = 1.58 [0.91-2.76] p = .107). Among the 132 patients who were LTFU, only 23 (17%) later returned to care, two-thirds (15/23) of whom returned with disease progression or complication. CONCLUSION One-third of glaucoma patients became LTFU over a 10-year period, and LTFU may be associated with poor clinical outcomes. More research is needed to understand reasons for LTFU and to promote regular glaucoma care.
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Affiliation(s)
- Andrew M Williams
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Tadhg Schempf
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peggy J Liu
- Department of Business Administration, Marketing and Business Economics Area, Joseph M. Katz Graduate School of Business, Pittsburgh, Pennsylvania, USA
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
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16
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Rajanala AP, Prager AJ, Park MS, Tanna AP. Association of the Effectiveness of Eye Drop Self-instillation and Glaucoma Progression. J Glaucoma 2022; 31:156-159. [PMID: 34999663 DOI: 10.1097/ijg.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/28/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Among patients with glaucoma or ocular hypertension, ineffective self-instillation of eye drops was associated with an increased long-term risk of progression or advancement of treatment to incisional surgery. PURPOSE The purpose of this study was to evaluate the association between the efficacy of self-instillation of eye drops and long-term glaucoma outcomes. METHODS In a previous study, video recordings of eye drop self-instillation by patients with glaucoma or ocular hypertension were graded as effective or ineffective depending on whether the patient successfully instilled at least 1 drop on the right ocular surface. Glaucomatous progression was then retrospectively defined as retinal nerve fiber layer thinning as measured by either optical coherence tomography, visual field progression, or need for incisional glaucoma surgery as determined by a glaucoma specialist unaware of patient performance in the eye drop instillation study. Subjects with at least 2 follow-up optical coherence tomography or visual field studies were included in the current study. RESULTS The original study enrolled 119 patients. Sufficient follow-up data were available for 101 patients. Eighty-eight patients (87.1%) were effective in eye drop instillation at baseline. Mean follow-up was 5.1 years, during which time 73 patients (72.3%) had progression or underwent incisional surgery in either eye. A significantly higher proportion of patients in the ineffective group met the criteria for progression or underwent incisional surgery (effective: 68.2%; ineffective: 100%; N=101; P=0.017, Fisher exact test). Kaplan-Meier survival analyses showed a significantly faster time to reaching an endpoint in the ineffective group (N=101; P=0.012, log-rank test). There was no difference in age, baseline intraocular pressure, or baseline retinal nerve fiber layer thickness between the groups. CONCLUSION Ineffective self-installation of eye drops was associated with an increased risk of glaucoma progression or treatment advancement to incisional surgery.
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Affiliation(s)
- Alekya P Rajanala
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL
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17
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Leiby BE, Hegarty SE, Zhan T, Myers JS, Katz LJ, Haller JA, Waisbourd M, Burns C, Divers M, Molineaux J, Henderer J, Brodowski C, Hark LA. A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma. Prev Chronic Dis 2021; 18:E52. [PMID: 34014814 PMCID: PMC8139485 DOI: 10.5888/pcd18.200567] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Appointment nonadherence is common among people with glaucoma, making it difficult for eye care providers to monitor glaucoma progression. Our objective was to determine whether the use of patient navigators, in conjunction with social worker support, could increase adherence to recommended follow-up eye appointments. Methods A randomized, controlled trial evaluated the effectiveness of an intervention that used patient navigators and social workers to improve patient adherence to follow-up eye care compared with usual care. Participants with glaucoma and other eye diseases (N = 344) were identified at primary care clinics in community settings through telemedicine screening of imaging and then randomized to enhanced intervention (EI) or usual care (UC). Data on participants’ visits with local ophthalmologists were collected for up to 3 years from randomization. Groups were compared for timely attendance at the first visit with the local ophthalmologist and adherence to recommended follow-up visits. Results Timely attendance at the first visit was higher for EI than UC (74.4% vs 39.0%; average relative risk [aRR] = 1.85; 95% CI, 1.51–2.28; P < .001). Rates of adherence to recommended annual follow-up during year 1 were 18.6% in the EI group and 8.1% in the usual care group (aRR = 2.08; 95% CI, 1.14–3.76; P = .02). The aRR across years 2 and 3 was 3.92 (95% CI, 1.24–12.43; P = .02). Conclusion An intervention using patient navigators and social workers doubled the rate of adherence to annual recommended follow-up eye care compared with usual care in community settings, and was effective at increasing connections with local ophthalmologists. Interventions to further improve long-term adherence are needed.
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Affiliation(s)
- Benjamin E Leiby
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Sarah E Hegarty
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Philadelphia, Pennsylvania
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Glaucoma Service, Wills Eye Hospital, 840 Walnut St, Ste 1110, Philadelphia PA 19107.
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Julia A Haller
- Thomas Jefferson University, Sidney Kimmel Medical College, Department of Ophthalmology, Philadelphia, Pennsylvania.,Wills Eye Hospital, Office of the Ophthalmologist-in-Chief, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Department of Ophthalmology, Tel Aviv Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Christine Burns
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Meskerem Divers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeanne Molineaux
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Jeffrey Henderer
- Temple University School of Medicine, Department of Ophthalmology, Philadelphia, Pennsylvania
| | - Charles Brodowski
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.,Columbia University Irving Medical Center, Department of Ophthalmology, New York, New York
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18
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Subathra GN, Rajendrababu SR, Senthilkumar VA, Mani I, Udayakumar B. Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India. Indian J Ophthalmol 2021; 69:1264-1270. [PMID: 33913874 PMCID: PMC8186660 DOI: 10.4103/ijo.ijo_164_21] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic. Methods: This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call. Results: 363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence. Conclusion: COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.
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Affiliation(s)
- G N Subathra
- Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | | | - Iswarya Mani
- Department of Biostatistics, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - B Udayakumar
- Lions Aravind Institute of Community Ophthalmology, Madurai, Tamil Nadu, India
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19
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Vu DM, Stoler J, Rothman AL, Chang TC. A Service Coverage Analysis of Primary Congenital Glaucoma Care Across the United States. Am J Ophthalmol 2021; 224:112-119. [PMID: 33340505 PMCID: PMC10619983 DOI: 10.1016/j.ajo.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the number of infants at risk of delayed primary congenital glaucoma (PCG) evaluation due to long travel times to specialists. DESIGN Cross-sectional geospatial service coverage analysis. METHODS All American Glaucoma Society (AGS) and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) provider locations were geocoded using each organization's member directory. Sixty-minute drive time regions to providers were generated using ArcGIS Pro (Esri). The geographic intersection of AGS and AAPOS service areas was computed because patients typically require visits to both types of specialists. American Community Survey data were then overlaid to estimate the number of infants within and beyond the AGS/AAPOS service areas. RESULTS One thousand twenty-nine AGS and 1,040 AAPOS provider locations were geocoded. The analysis yielded 944,047 infants age 0-1 year (23.6%) who live beyond the AGS/AAPOS service areas. Therefore, approximately 14-94 new PCG cases/year may be at risk of delayed diagnosis as a result of living in a potential service desert. Compared with children living within the AGS/AAPOS service areas, children aged <6 years in these potential service deserts were more likely to live in households earning below the US federal poverty level, lack health insurance, and live in a single-parent home. These communities are disproportionately likely to experience other rural health disparities and are more prevalent across the Great Plains. CONCLUSION Service coverage analysis is a useful tool for identifying underserved regions for PCG referrals and evaluation. These data may assist in targeting screening programs in low access areas for pediatric glaucoma care.
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Affiliation(s)
- Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA.
| | - Justin Stoler
- Department of Geography and Regional Studies, University of Miami, Coral Gables, Florida, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA
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20
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Lu YC, Pu C, Hou CH. The Effect of Continuity of Care and Provider Volume on Late Presentation of Glaucoma: A Nested Case-Control Study. J Glaucoma 2021; 30:187-191. [PMID: 33031188 DOI: 10.1097/ijg.0000000000001695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
PRCIS Glaucoma late presentation is not associated with continuity of care. However, it is associated with frequency of physician visits and physician volume. PURPOSE Late presentation of glaucoma often causes blindness. Continuity of care (COC) has been the central element in primary care. We investigated whether COC, frequency of visits to ophthalmology departments, and provider experience can reduce late presentation. METHODS We conducted a nested case-control study on patients aged above 20 years with confirmed glaucoma diagnosis. Claims data from the Taiwan's National Health Insurance Research Database during 2007 to 2016 were linked to the Disability Registry (n=231,330) to identify patients with glaucoma late presentation. Physician experience was proxied using service volume. Logistic regression was estimated using matched samples. RESULTS A total of 111 patients satisfied the definition of late presentation. Patients with a low frequency of visits had lower odds of being in the late-presentation group (odds ratio=0.39, 95% confidence interval=0.18-0.81). COC index did not statistically affect late presentation. Old age and lower socioeconomic status were significantly associated with higher odds of late presentation. A statistically significant negative association was observed between physician volume and odds of late presentation. CONCLUSION Late presentation for glaucoma can be reduced by promoting more frequent physician visits. However, enhancement from the provider-side, such as spreading awareness and offering routine tests, also play essential role in reducing late presentation.
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Affiliation(s)
- Yu-Chin Lu
- Institute of Hospital and Health Care Administration
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei
| | - Chiun-Ho Hou
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Xiamen, People's Republic of China
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21
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Achilleos M, Merkouris A, Charalambous A, Papastavrou E. Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol. BMJ Open 2021; 11:e039788. [PMID: 33472775 PMCID: PMC7818806 DOI: 10.1136/bmjopen-2020-039788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. METHODS AND ANALYSIS This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). SAMPLE Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). ETHICS AND DISSEMINATION Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.
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Affiliation(s)
- Maria Achilleos
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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22
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Follow-up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center. Am J Ophthalmol 2021; 221:48-54. [PMID: 32858028 DOI: 10.1016/j.ajo.2020.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the percent adherence to follow-up for patients with pediatric glaucomas seen at a tertiary care center and to elucidate risk factors. DESIGN Retrospective cohort study. METHODS Patients with pediatric glaucomas seen at the University of Minnesota over 8.5 years were classified as adherent, nonadherent, or lost to tertiary follow-up if they followed up within 0-30 days, between 31 and 180 days, or later than 180 days of the recommended appointment time or never, respectively. RESULTS Of 176 patients analyzed, 95 (54%) were adherent (51% male; mean [standard deviation (SD)] age: 56.1 [59.8] months), 5 (3%) were nonadherent (20% male; mean [SD] age: 25.0 [35.8] months), and 76 (43%) were lost to tertiary follow-up (55% male; mean [SD] age: 58.9 [53.1] months). Multiple logistic regression analysis of variables that were significant in isolation revealed that only race (white: odds ratio, 3.58; 95% confidence interval, 1.42-9.05; P = .007) and distance from the eye clinic (per 50 miles: odds ratio, 0.79; 95% confidence interval, 0.67-0.92; P = .003) significantly impacted adherence. CONCLUSIONS This is the first study of adherence to follow-up recommendations for patients with pediatric glaucomas. Percent adherence to follow-up appointments was alarmingly low, and decreased adherence was observed with non-white race and increased distance to the eye clinic. Physicians should consider these risk factors when risk-stratifying patients with pediatric glaucomas for nonadherence to follow-up. Additional studies to improve adherence through interventions that reduce biases and barriers to follow-up are needed.
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23
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Rothman AL, Stoler JB, Vu DM, Chang TC. A Geodemographic Service Coverage Analysis of Travel Time to Glaucoma Specialists in Florida. J Glaucoma 2020; 29:1147-1151. [PMID: 33264165 DOI: 10.1097/ijg.0000000000001648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Approximately 1 in 9 Florida residents over the age of 65 years (438,642 people) live more than an hour away from a glaucoma specialist, which represents a significant barrier to care. PURPOSE To describe access to glaucoma care for Florida's elderly population using travel time to American Glaucoma Society (AGS) member offices. METHODS For this cross-sectional service coverage analysis, a list of AGS member locations was extracted from the AGS website, and addresses were geocoded using ArcGIS Online. Driving time regions were created using the service area tool in ArcGIS Pro 2.4 and overlaid with 2010 United States Census and 2016 American Community Survey data for all Florida residents age 65 or older. RESULTS Fifty-eight AGS member providers with 65 locations were identified and geocoded. There were 3,797,625 individuals aged over 65 years in Florida, of which 1,153,320 (30.4%) lived within 15 minutes of driving time from an AGS provider's office, 2,586,825 (68.1%) within 30 minutes, 3,358,983 (88.4%) within 60 minutes, and 3,491,815 (91.9%) within 120 minutes. The areas with the lowest access include rural areas near Lake Okeechobee and the Florida Panhandle. The population living beyond a 60-minute drive was more likely to be White, non-Hispanic and older, but less likely to be living below the federal poverty level or receiving public assistance than the population living within a 60-minute drive. CONCLUSIONS There is a significant travel burden for the elderly community of Florida to reach AGS providers. Additional studies could help identify other social barriers to accessing glaucoma providers in Florida and beyond in an effort to improve patient compliance and, ultimately, vision outcomes.
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Affiliation(s)
- Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Justin B Stoler
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami
- Department of Geography and Regional Studies, University of Miami, Coral Gables, FL
| | - Daniel M Vu
- Bascom Palmer Eye Institute, University of Miami Health System
| | - Ta C Chang
- Bascom Palmer Eye Institute, University of Miami Health System
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24
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Kanu LN, Jang I, Oh DJ, Tiwana MS, Mehta AA, Dikopf MS, Vajaranant TS, Aref AA, Edward DP. Glaucoma Care of Prison Inmates at an Academic Hospital. JAMA Ophthalmol 2020; 138:358-364. [PMID: 32077908 DOI: 10.1001/jamaophthalmol.2020.0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges. Objectives To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics. Design, Setting, and Participants This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017. Main Outcomes and Measures Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018. Results In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P = .02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P = .02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up. Conclusions and Relevance Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
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Affiliation(s)
- Levi N Kanu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Inae Jang
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Daniel J Oh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Manpreet S Tiwana
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Amy A Mehta
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Mark S Dikopf
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | | | - Ahmad A Aref
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Deepak P Edward
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.,King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Aptel F, Toren A. Societal and Economic Impact of Poor Glaucoma Medication Adherence. Ophthalmology 2020; 127:599-600. [PMID: 32327131 DOI: 10.1016/j.ophtha.2020.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022] Open
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Gao X, Obeid A, Adam MK, Hyman L, Ho AC, Hsu J. Loss to Follow-Up in Patients With Retinal Vein Occlusion Undergoing Intravitreal Anti-VEGF Injections. Ophthalmic Surg Lasers Imaging Retina 2019; 50:159-166. [PMID: 30893449 DOI: 10.3928/23258160-20190301-05] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To identify the proportion of patients with retinal vein occlusion (RVO) with loss to follow-up (LTFU) along with potential risk factors after receiving an intravitreal anti-vascular endothelial growth factor (VEGF) injection. PATIENTS AND METHODS A retrospective review based on billing codes was performed from January 1, 2012, to January 1, 2017. LTFU was defined as no office visit within 12 months following an intravitreal injection. Potential risk factors for LTFU were screened using univariate analysis for inclusion in a final multivariate logistic regression model. RESULTS A total of 3,400 unique patients with RVO with macular edema met the study inclusion criteria. Of these, 863 patients (25.4%) were LTFU. Rates of LTFU varied based on race / ethnicity, age, RVO type, distance from clinic, insurance status, and regional average adjusted gross income. In the multivariate analysis, patients with LTFU were more likely to be black (odds ratio [OR] = 1.37), Hispanic (OR = 2.37), and living more than 20 miles away from clinic (OR = 1.47). Patients who were 65 to 80 years old (OR = 0.71) and those with branch retinal vein occlusion (OR = 0.70) were less likely to be LTFU. Subgroup analysis showed that patients with baseline visual acuity better than 20/50 were also less likely to be LTFU. CONCLUSIONS Approximately one in four patients did not return for a year or more after receiving an intravitreal injection for RVO. Given the importance of ongoing therapy to prevent vision loss, these "real-world" findings are of significant concern. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:159-166.].
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Gao X, Obeid A, Aderman CM, Talcott KE, Ali FS, Adam MK, Rovner BW, Hyman L, Ho AC, Hsu J. Loss to Follow-up After Intravitreal Anti-Vascular Endothelial Growth Factor Injections in Patients with Diabetic Macular Edema. Ophthalmol Retina 2018; 3:230-236. [PMID: 31014699 DOI: 10.1016/j.oret.2018.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/22/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the rate of loss to follow-up (LTFU) and associated risk factors in patients with nonproliferative diabetic retinopathy (NPDR) who had diabetic macular edema (DME) and were receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections. DESIGN Retrospective cohort study. PARTICIPANTS A total of 2595 NPDR patients with DME who received at least one anti-VEGF injection at a single large retina practice from January 1, 2012, to January 1, 2017. METHODS A retrospective review based on billing codes was performed. LTFU was defined as no subsequent office visits within 12 months after an intravitreal injection. Patient demographics and clinical features were evaluated, and logistic regression was used to identify independent predictors for LTFU. MAIN OUTCOME MEASURES LTFU rates and potential risk factors. RESULTS LTFU was found in 413 (25.3%) of 1632 patients. Examining LTFU by racial groups, 21.3% identified themselves as white, 29.1% as black, 30.6% as Asian, and 35.0% as Hispanic (P < 0.001). A difference in LTFU was also found based on average adjusted gross income (AGI) (P < 0.001) and NPDR stage (P = 0.04). In the multivariate model, factors associated with LTFU included Hispanic (odds ratio [OR] 1.66), American Indian, Pacific Islander, multiple races (OR 2.60), and unknown race (OR 1.59) compared with those who were white. Additional factors included those with an average AGI of $50000 to $75000 (OR 1.37) and <$50000 (OR 1.88) compared with those with an average AGI > $75000. Based on subgroup analysis of patients with available visual acuity data, a significant association was found between decreasing baseline vision and LTFU (P < 0.001). CONCLUSIONS Approximately 1 in 4 patients with NPDR who had DME had no follow-up visit for at least 1 year after an anti-VEGF injection. Given the importance of ongoing therapy, these real-world findings may help identify at-risk groups for noncompliance with care.
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Affiliation(s)
- Xinxiao Gao
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Anthony Obeid
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher M Aderman
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine E Talcott
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ferhina S Ali
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Murtaza K Adam
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Barry W Rovner
- Departments of Psychiatry and Neurology, Jefferson Medical College, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Momoh RO, Bunce C, Oko-oboh GA, Gilbert CE. Advanced glaucoma at presentation is associated with poor follow-up among glaucoma patients attending a tertiary eye facility in Southern Nigeria. Ophthalmic Epidemiol 2018; 25:266-272. [DOI: 10.1080/09286586.2018.1424345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rita Omoso Momoh
- Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Catey Bunce
- Department of Primary Care & Public Health, Kings College London, London, United Kingdom
| | | | - Clare E. Gilbert
- London School of Hygiene & Tropical Medicine, International Centre for Eye Health (ICEH), London, United Kingdom
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Abstract
PURPOSE To explore why glaucoma patients believe that glaucoma continues to cause vision loss despite the availability of effective treatment. METHODS Nine focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 56 participants, 31 with poor vision and 25 with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme. RESULTS A total of 474 relevant comments were made in the 9 focus groups. Focus groups elicited 305 comments about barriers to glaucoma management including issues with adherence (30%), the doctor-patient relationship (21%), knowledge about glaucoma (19%), personal support systems (19%), and barriers to health care delivery such as cost and insurance (11%). A total of 101 comments were made regarding feelings about glaucoma and 58 comments were made regarding beliefs about disease and treatment. CONCLUSIONS These focus groups brought up many issues surrounding barriers to glaucoma treatment, perceived susceptibility to glaucoma, perceived benefits to treatment, and the emotional response to living with glaucoma. There is a need to create a more comprehensive chronic disease management approach for patients with glaucoma to address both the concrete and emotional issues identified in these focus group discussions.
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Liang YB, Zhang Y, Musch DC, Congdon N. Proposing new indicators for glaucoma healthcare service. EYE AND VISION 2017; 4:6. [PMID: 28286786 PMCID: PMC5341480 DOI: 10.1186/s40662-017-0071-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/20/2017] [Indexed: 01/17/2023]
Abstract
Glaucoma is the first leading cause of irreversible blindness worldwide with increasing importance in public health. Indicators of glaucoma care quality as well as efficiency would benefit public health assessments, but are lacking. We propose three such indicators. First, the glaucoma coverage rate (GCR), which is the number of people known to have glaucoma divided by the total number of people with glaucoma as estimated from population-based studies multiplied by 100%. Second, the glaucoma detection rate (GDR), which is number of newly diagnosed glaucoma patients in one year divided by the population in a defined area in millions. Third, the glaucoma follow-up adherence rate (GFAR), calculated as the number of patients with glaucoma who visit eye care provider(s) at least once a year over the total number of patients with glaucoma in given eye care provider(s) in a specific period. Regularly tracking and reporting these three indicators may help to improve the healthcare system performance at national or regional levels.
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Affiliation(s)
- Yuan Bo Liang
- Clinical and Epidemiological Eye Research Center, The Eye Hospital of Wenzhou Medical University, Wenzhou, China.,Centre for Public Health, Queens University, Belfast, UK.,Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical College, No. 270, Xue Yuan Xi Road, Wenzhou, Zhejiang 3250027 China
| | - Ye Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - David C Musch
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI USA
| | - Nathan Congdon
- Centre for Public Health, Queens University, Belfast, UK
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Kim YK, Jeoung JW, Park KH. Understanding the reasons for loss to follow-up in patients with glaucoma at a tertiary referral teaching hospital in Korea. Br J Ophthalmol 2016; 101:1059-1065. [DOI: 10.1136/bjophthalmol-2016-309103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/11/2016] [Accepted: 11/17/2016] [Indexed: 12/15/2022]
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Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project. J Glaucoma 2016; 25:e821-e825. [DOI: 10.1097/ijg.0000000000000409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pizzi LT, Tran J, Shafa A, Waisbourd M, Hark L, Murchison AP, Dai Y, Mayro EL, Haller JA. Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:229-40. [PMID: 26924099 DOI: 10.1007/s40258-016-0231-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. OBJECTIVES The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. METHODS This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. RESULTS Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. CONCLUSIONS A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
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Affiliation(s)
- Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Room 911, Philadelphia, PA, 19107, USA.
| | - Judie Tran
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Anousheh Shafa
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Lisa Hark
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Ann P Murchison
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Julia A Haller
- Wills Eye Hospital, 840 Walnut Street Suite 1500, Philadelphia, PA, USA
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Effectiveness of Glaucoma Counseling on Rates of Follow-up and Glaucoma Knowledge in a South Indian Population. Am J Ophthalmol 2016; 163:180-189.e4. [PMID: 26705095 DOI: 10.1016/j.ajo.2015.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the impact of traditional counseling and patient-centered counseling, either alone or with recorded audio counseling reinforcement, on glaucoma knowledge and clinical follow-up. DESIGN Prospective randomized controlled trial. METHODS Newly diagnosed adult glaucoma patients were randomized to 1 of 3 categories of glaucoma counseling: traditional counseling, patient-centered counseling, or patient-centered counseling with audio counseling reinforcement. Demographic and clinical information from each subject was ascertained, and all subjects completed the Glaucoma Knowledge Assessment before and after counseling sessions at the time of diagnosis and at 1-month follow-up. Patients were instructed to return to clinic for routine follow-up at 1, 3, 6, 9, and 12 months after enrollment. A multivariate logistic regression model was used to determine factors associated with appropriate clinical follow-up. RESULTS Overall, only 13.5% of subjects had appropriate clinical follow-up at 1 year, defined as attending at least 3 follow-up visits during that interval, and there was no significant difference between counseling groups. The mean glaucoma knowledge assessment score (GKAS) improved by 77.6% with the initial counseling intervention (P < .0001), decreased by 17.4% within a 1-month period following initial counseling, and improved by 22.8% (P < .001) after the second counseling intervention. Monthly household income over 2500 rupees, GKAS greater than 5 after initial counseling, and undergoing any ocular surgical procedure were all independent predictors of appropriate follow-up. CONCLUSION While all 3 counseling methods resulted in transient improvement of patient knowledge regarding glaucomatous disease, follow-up rates were poor for all groups. Poor retention of glaucoma knowledge may impact the likelihood of patient follow-up, and reinforcement with repeated counseling may be beneficial with regard to both disease knowledge and follow-up.
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Hark LA, Johnson DM, Berardi G, Patel NS, Zeng L, Dai Y, Mayro EL, Waisbourd M, Katz LJ. A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence. Patient Prefer Adherence 2016; 10:1739-48. [PMID: 27660423 PMCID: PMC5019463 DOI: 10.2147/ppa.s108391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Patients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings. PATIENTS AND METHODS Patients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05. RESULTS A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±standard deviation) was 71.2 (±10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (±standard deviation) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of ≥1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11). CONCLUSION Help from a patient navigator did not increase the likelihood of keeping ≥1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.
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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
- Correspondence: Lisa A Hark, Department of Research, Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA, Tel +1 215 928 3045, Fax +1 215 928 9085, Email
| | - Deiana M Johnson
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Giuliana Berardi
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Neal S Patel
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Lichuan Zeng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
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Coleman AL, Lum FC, Velentgas P, Su Z, Gliklich RE. Impact of treatment strategies for open angle glaucoma on intraocular pressure: the RiGOR study. J Comp Eff Res 2015; 5:87-98. [PMID: 26691269 DOI: 10.2217/cer.15.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The RiGOR study's primary outcome measure was a 15% reduction in intraocular pressure (IOP) for patients with open-angle glaucoma at 1 year. METHODS Patients received treatment according to the ophthalmologist's usual practice. RESULTS A higher proportion of patients in the incisional and other surgery group achieved a 15% reduction in IOP than in the laser surgery or additional medication groups (82, 57, and 57% respectively). In multivariate regression analyses, incisional surgery patients were 2.7-times as likely as patients treated with additional medication to achieve a 15% reduction in IOP (odds ratio: 2.67; 95% CI: 2.01-3.57). CONCLUSION Incisional and other surgical procedures are effective treatments. There were no differences in treatment response by race or ethnicity.
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Affiliation(s)
- Anne L Coleman
- Jules Stein Eye Institute, David Geffen School of Medicine & Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.,H Dunbar Hoskins, Jr MD Center for Quality Eye Care, Foundation of the American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109, USA
| | - Flora C Lum
- H Dunbar Hoskins, Jr MD Center for Quality Eye Care, Foundation of the American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109, USA
| | - Priscilla Velentgas
- Outcome DEcIDE Center, Quintiles Real World & Late Phase Research, Cambridge, MA 02139, USA
| | - Zhaohui Su
- Outcome DEcIDE Center, Quintiles Real World & Late Phase Research, Cambridge, MA 02139, USA
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Ung C, Spaeth GL, Lin SC, Singh K. Failure of Glaucoma Follow-up Compliance. Am J Ophthalmol 2015; 160:1089-1090.e1. [PMID: 26391611 DOI: 10.1016/j.ajo.2015.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Cindy Ung
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
| | - George L Spaeth
- Glaucoma Service, Wills Eye Institute, Philadelphia, Pennsylvania
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Kuldev Singh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
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Tamrat L, Gessesse GW, Gelaw Y. Adherence to topical glaucoma medications in Ethiopian patients. Middle East Afr J Ophthalmol 2015; 22:59-63. [PMID: 25624675 PMCID: PMC4302478 DOI: 10.4103/0974-9233.148350] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia. Materials and Methods: A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant. Result: Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment. Conclusion: A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.
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Affiliation(s)
- Lemlem Tamrat
- Department of Ophthalmology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yeshigeta Gelaw
- Department of Ophthalmology, Jimma University, Jimma, Ethiopia
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