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  • Improving Follow-Up Attendance Rates in the SToP Glaucoma Study

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, April 2018

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    Eye exam schedules can be challenging for underserved populations. Zhao et al. aimed to determine the factors associated with attaining follow-up care among patients with positive findings on initial screenings. They found that follow-up attendance rates can be im­proved by combining standard strate­gies with less-traditional ones.

    SToP Glaucoma is an ongoing proj­ect from the U.S. Centers for Disease Control and Prevention to implement an effective program for detecting glau­coma and other eye diseases in high-risk individuals. It focuses on African Americans aged 50 and older who live in urban areas of Baltimore. A goal of the project is to screen 9,000 individu­als during a 5-year period.

    The initial ophthalmic screening occurs in a local community venue, where trained personnel administer a questionnaire, measure visual acuity (VA) and intraocular pressure (IOP), and conduct visual field testing and imaging studies. Individuals with positive findings are referred for subse­quent examination at the Wilmer Eye Institute. Patients receive the screenings at no cost.

    In the first phase of the study, stan­dard methods of follow-up—such as personal reminders via telephone and email—were used. Free transportation was offered to those who needed it. Additional contact efforts were made when a patient did not attend his or her follow-up appointment.

    The second phase of the study included supplemental strategies to encourage follow-up: providing pa­tients with vouchers stating the value of the exam, prescheduling follow-up visits within 4 weeks of initial screen­ing, and showing educational videos to reinforce the importance of continuing care. Multivariable logistic regression was used to detect associations between follow-up attendance and demograph­ic, general medical, and ocular factors.

    The attendance rate for referred pa­tients in the first phase of the study was 55.0%, which increased to 63.8% in the second phase. Fully adjusted models yielded the following odds ratios: 1.82 for screening in phase 2 versus phase 1; 0.62 for screening sites that were 3 to < 5 miles versus < 1 mile from the hospital; 1.70 for body mass index ≥ 30 kg/m2 versus < 25 kg/m2; 2.03 for presenting VA < 20/40 versus ≥ 20/40; 2.32 for ab­normal versus normal macula; and 2.19 for IOP ≥ 23 mm Hg versus < 23 mm Hg.

    The original article can be found here.