Glaucoma

Increased Travel Distances Are A Barrier To Postoperative Glaucoma Care, Study Shows

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November 18, 2020

KNOXVILLE, TENNESSEE – FEBRUARY 01: A woman looks at eye glasses at a Remote Area Medical Clinic (RAM) on February 01, 2019 in Knoxville, Tennessee. Friday is the first day of treatment for the three day clinic in what will be the health organization’s 1000th clinic. More than a thousand people are expected seeking free dental, medical and vision care at the event. RAM provides free medical care through mobile clinics in underserved, isolated, or impoverished communities around the country and world. As health-care continues to be a contentious issue in America, an estimated 29 million Americans, about one in 10, lack coverage. (Photo by Spencer Platt/Getty Images)

The further patients live from a clinic and interstate access, the greater the odds that they will miss appointments for follow-up care after glaucoma surgery, according to a new study in the Journal of Glaucoma.

Researchers found that, in the 6 months following surgical procedures, patients who lived more than 50 miles away from a clinic were less likely to follow-up, compared with patients who lived less than 25 miles away. Patients who lived more than 50 miles away missed more appointments than those 25 to 50 miles and less than 25 miles away. And patients whose homes were more than 20 miles from interstate access dropped out more than those less than 10 miles away.

The study looked at adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018, who were treated at the University of North Carolina at Chapel Hill’s Kittner Eye Center.

Patients younger than 18 years were excluded from the study, as were institutionalized patients or those with managed care.

The study included 199 patients, who lived anywhere from 0.5 miles to 114 miles away from the clinic. Researchers recorded information about their corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data.

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Patients who missed or didn’t schedule follow-up appointments as recommended by their provider and didn’t return to the clinic within the 6-month postoperative period were listed as “lost to follow-up.”

Researchers sorted the patients into groups according to distance from the clinic: 0 to 25 miles, 25.5 to 50 miles and more than 50 miles from home address to the clinic. They also split the patients into groups based on the distance from their homes to interstate access: 0 to 10 miles, 10.5 to 20 miles and more than 20 miles.

Patients living more than 50 miles from the clinic had increased odds of not following-up in comparison with those less than 25 miles away (OR, 3.47; 95% CI, 1.24-4.12; P <0.05). Patients 25 to 50 miles from the clinic were not more likely to be lost to follow-up compared with those living less than 25 miles away (OR, 1.58; 95% CI, 0.59-4.11; P =.35). The harder it was for patients to get access to an interstate, the greater their chances of not following up.

Also, patients covered by North Carolina Medicaid had more missed appointments than those with Medicare (t(144)=−2.19311; P <.05; M=1.03; MD=0.35; 95% CI, 0.57-0.87).

But no significant differences in missed appointments or loss to follow-up were found between privately insured patients and those with Medicare or Medicaid (P >.05).

The study’s findings are particularly important because United States-based follow-up studies in ophthalmology are scarce, according to the research.

The researchers suggest that the risks and benefits of surgical treatments for individual patients should be weighed against the likelihood of patients maintaining follow-up visits—and the distance the patient travels for care is an important factor.

Reference

Funk I, Strelow B, Klifto M, et al. The relationship of travel distance to postoperative follow-up care on glaucoma surgery outcomes. J Glaucoma. 2020;29(11):1056-1064 doi: 10.1097/IJG.0000000000001609