By Gail F. Schwartz, MD
This study reports the results of a survey suggesting that demographic factors, including race, ethnicity and educational background, affect adherence to recommended glaucoma follow-up visits. Black and Latino patients demonstrated, on average, less consistent follow-up relative to white patients. The results suggest that patients from these two groups may benefit from specialized education regarding irreversible vision loss from glaucoma, need for lifelong treatment of the condition and lack of visual symptoms, as well as counseling to improve follow-up. It has been well documented that patients who do not maintain follow-up appointments are less adherent with medication. The study's authors say that targeted glaucoma education by physicians may improve follow-up, thereby decreasing the morbidity associated with glaucomatous disease.
The authors conducted this case-control study in order to identify predictors of inconsistent attendance at glaucoma follow-up visits in an urban county hospital population. Subjects were 152 glaucoma patients equally divided between those with inconsistent follow-up (cases) and those with consistent follow-up (controls). Data were collected via oral questionnaire.
After adjusting for covariates in the logistic regression analysis, factors independently associated with inconsistent follow-up included black race (adjusted OR, 7.16; 95% confidence interval, 1.64-31.24), Latino ethnicity (adjusted OR, 4.77; 1.12-20.29), unfamiliarity with necessary treatment duration (adjusted OR, 3.54; 1.26- 9.94), lack of knowledge of the permanency of glaucoma-induced vision loss (adjusted OR, 3.09; 1.18-8.04) and the perception that it is not important to attend all follow- up visits (adjusted OR, 3.54; 1.26-9.94). Latino patients with a low level of education (i.e., no formal education through completion of primary school) and black patients with a medium level of education (i.e., any secondary school through completion of a secondary school degree or a general educational development certificate) were more likely to have inconsistent follow-up patterns compared with their white counterparts with similar educational backgrounds (P = 0.04 for each).
The authors say these results are consistent with the trends of lower follow-up and screening rates observed among black and Latino patients with breast and cervical cancer compared with their white counterparts. It is somewhat unexpected that ability to pay for visits and medications did not show a correlation. Family history was not assessed.
This study covers a more broad racial and ethnic population than similarly designed studies. Among the cases, 27.6 percent were black, 40.8 percent Latino, 23.7 percent Asian and 7.9 percent white. The proportion of cases within each race or ethnicity was 61.8 percent black, 54.4 percent Latino, 42.9 percent Asian and 31.6 percent white.
However, the study size is small and the results of questionnaires should be interpreted cautiously. Several studies have shown that patients are more likely to provide the answer they believe their physician wants to hear.