Improving Follow-Up Attendance Rates in the SToP Glaucoma Study
By Lynda Seminara
Selected By: Richard K. Parrish II, MD
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.