When a patient experiences an ocular trauma, or an acute issue with their vision, they’re likely to end up in the emergency department. In fact, visits to the emergency department for ophthalmic conditions increase each year. But after that initial emergency visit, many patients are unlikely to follow up with an ophthalmologist.
A recent study published in the American Journal of Ophthalmology evaluated the reasons so many patients with ophthalmic emergencies are lost to follow up. The researchers analyzed the medical records of more than 2000 patients with eye-related concerns at the Yale New Haven Hospital emergency department. All patients received orders for a follow-up appointment with an ophthalmologist. A quarter of them (25.2%) didn’t even schedule one.
Even with a major increase in scheduled follow-up appointments from 2013 to 2019 , the lost-to-follow-up rate didn’t shift much from year to year, remaining at approximately 30%, the study shows. In particular, patients who had other non-ophthalmic referrals on discharge (odds ratio [OR], 1.73; 95% CI, 1.30-2.30; p<0.001), a nonurgent ophthalmic condition (OR, 1.59; 95% CI, 1.23-2.03; p<0.001), a follow-up appointment scheduled more than 5 days after the emergency visit (OR, 2.71; 95% CI, 2.10-3.51; p<0.001) and visual acuity of 20/40 or better on presentation (OR, 1.40; 95% CI, 1.04-1.90; p=0.02) were significantly more likely to be lost to follow up.
The authors pointed to several variables behind this phenomenon. Access to health insurance proved a major barrier, with approximately 28% of uninsured subjects lost to follow up. Medicaid insurance was also associated with a higher than 30% lost-to-follow-up rate. Patient age and sex factored in as well, with younger males least likely to follow up, according to the authors. Wait times to see an ophthalmologist also impacted a patient’s willingness to return for care. Patients with an appointment more than five days after being discharged from the emergency department were three times more likely to be lost to follow up, even after controlling for the urgency of the condition, the authors report.
The faster a patient was able to get a follow-up appointment, the higher their show rate, according to the study, which demonstrated that 80.2% of subjects who had a follow-up appointment booked within a week of their visit to the emergency department followed through. The show rate dropped significantly to only 43.5% when patients had a follow-up appointment more than three weeks after their initial emergency visit.
The study also found the younger the patients are, the less likely they are to follow-up. They’re also less likely to participate in a diabetic retinopathy screening.
“Ophthalmologist appointments may be perceived as specialist care with potentially higher cost-sharing burdens among socioeconomically disadvantaged populations,” the authors wrote. They added, “it is plausible that patients with ophthalmic follow-up were more likely to receive a correct diagnosis and appropriate treatment.“
Researchers also found that patients whose primary diagnosis was an ophthalmic condition (OR, 0.07; 95% CI, 0.03-1.15; P <0.001) or who had a history of
prior ophthalmology appointments (odds ratio, 0.68; 95% CI, 0.47-0.99; P =0.045) were less likely to be lost to follow up.
Chen E, Ahluwalia A, Parikh R, Nwanyanwu K. Ophthalmic Emergency Department Visits: Factors Associated with Loss to Follow-up. Am J Ophthalmol. Published online August 31, 2020. doi: https://doi.org/10.1016/j.ajo.2020.08.038.