Loss to Follow Up Among Glaucoma Patients: An IRIS® Registry (Intelligent Research in Sight) Retrospective Cohort Analysis.

PURPOSE: To identify prevalence of and risk factors for loss to follow up (LTFU) among a national cohort of patients with primary open-angle glaucoma (POAG). METHODS: This retrospective cohort study analyzed data from the IRIS® Registry (Intelligent Research in Sight) database from 2014 through 2019 to assess LTFU among adult patients with POAG. POAG patients with at least one clinical encounter in 2014 were included. LTFU was defined as exceeding one year without a clinical encounter during the study period. RESULTS: Among 553,663 glaucoma patients, 277,019 (50%) became LTFU, of whom 184,548 (67%) never returned to care and 92,471 (33%) re-established follow-up after a lapse. Risk of LTFU was greatest among those younger than 60 years (RR = 1.38; 95% CI: 1.36-1.39) or older than 80 years (RR = 1.39; 95% CI: 1.38-1.40) compared to those in their 60s. Compared to White race, risk for LTFU was highest among Native Hawaiian/Pacific Islander (RR = 1.24; 95% CI: 1.17-1.31), Hispanic ethnicity (RR = 1.19; 95% CI: 1.18-1.20), and Black race (RR = 1.10; 95% CI: 1.09-1.11). Medicare insurance was associated with lower risk of LTFU (RR = 0.79; 95% CI: 0.78-0.79), whereas unknown/missing/no insurance was associated with greater risk (RR = 1.33; 95% CI: 1.32-1.34), compared to private insurance. Compared to mild-stage POAG, risk of LTFU was higher for moderate-stage (RR = 1.10; 95% CI: 1.08-1.13) and severe-stage disease (RR = 1.35; 95% CI: 1.32-1.38). CONCLUSION: We found a 50% prevalence of LTFU among POAG patients in the IRIS Registry over a 6-year study period, with greater risk among minority groups and those with more advanced disease.

Factors Associated with Nonreturn after Loss to Follow-Up from Glaucoma Care: An IRIS® Registry Retrospective Analysis.

PURPOSE: Loss to follow-up (LTFU) in primary open-angle glaucoma (POAG) can lead to undertreatment, disease progression, and irreversible vision loss. Patients who become LTFU either eventually re-establish glaucoma care after a lapse or never return to the clinic. The purpose of this study is to examine a large population of patients with POAG who became LTFU to determine the proportion that return to care and to identify demographic and clinical factors associated with nonreturn after LTFU. DESIGN: Retrospective longitudinal cohort study. PARTICIPANTS: Patients with a diagnosis of POAG with a clinical encounter in 2014 in the IRIS® Registry (Intelligent Research in Sight). METHODS: We examined follow-up patterns for 553 663 patients with POAG who had an encounter in the IRIS Registry in 2014 by following their documented clinic visits through 2019. LTFU was defined as exceeding 1 calendar year without an encounter. Within the LTFU group, patients were classified as returning after a lapse in care (return after LTFU) or not (nonreturn after LTFU). MAIN OUTCOME MEASURES: Proportion of patients with nonreturn after LTFU and baseline demographic and clinical characteristics associated with nonreturn among LTFU patients with POAG. RESULTS: Among 553 663 patients with POAG, 277 019 (50%) had at least 1 episode of LTFU over the 6-year study period. Within the LTFU group, 33% (92 471) returned to care and 67% (184 548) did not return to care. Compared to those who returned to care, LTFU patients with nonreturn were more likely to be older (age >80 years; relative risk [RR] = 1.48; 95% confidence interval [CI]: 1.47-1.50), to have unknown/missing insurance (RR = 1.31; 95% CI: 1.30-1.33), and to have severe-stage POAG (RR = 1.13; 95% CI: 1.11-1.15). Greater POAG severity and visual impairment were associated with nonreturn with a dose-dependent relationship in the adjusted model that accounted for demographic characteristics. Among those with return after LTFU, almost all returned within 2 years of last appointment (82 201; 89%) rather than 2 or more years later. CONCLUSIONS: Half of patients with POAG in the IRIS Registry had at least 1 period of LTFU, and two thirds of LTFU patients with POAG did not return to care. More effort is warranted to re-engage the vulnerable patients with POAG who become LTFU. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Effect of a Patient Portal Reminder Message After No-Show on Appointment Reattendance in Ophthalmology: A Randomized Clinical Trial.

PURPOSE: To assess the efficacy of electronic health record (EHR) messaging for re-engaging patients with ophthalmology care after a missed appointment. DESIGN: Prospective, randomized clinical trial. METHODS: The study setting was an academic ophthalmology department. The patient population comprised of return patients age 18 years or older with an appointment "no show," or missed appointment. Over 2 phases of recruitment, 362 patients with an active patient portal in the EHR were selected consecutively each business day. Patients were randomized using a web-based tool to receive a reminder to reschedule via a standard mailed letter only (control) or the mailed letter plus an electronic message through the EHR within 1 business day of the missed appointment (intervention). Reengagement with eye care was defined as attendance of a rescheduled appointment within 30 days of the no-show visit. Patient charts were reviewed for demographic and clinical data. RESULTS: The average age of recruited patients was 59.9 years, just under half of the sample was male (42.5%, 154/362), and most patients were White (56.9%, 206/362) or Black (36.2%, 131/362). Patients were most commonly recruited from the retina service (39.2%, 142/362) followed by the glaucoma service (29.3%, 106/362). Many patients in this study had previous no-show appointments, with an average no-show rate of 18.8% out of all scheduled visits across our health system. In total, 22.2% (42/189) of patients in the intervention group attended a follow-up appointment within 30 days of their no-show visit compared to 11.6% (20/173) of the control group (OR, 2.186; 95% CI, 1.225-3.898; P = .008). When including only the 74 patients in the intervention group who read the intervention message in the patient portal, 28.4% (21/74) attended a follow-up compared to 11.6% (20/173) of the control group (P = .001). CONCLUSIONS: EHR-based reminder messages sent within a business day of a missed appointment may promote re-engagement in ophthalmology care after appointment no-show.

Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program.

PRCIS: Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling. PURPOSE: The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program. MATERIAL AND METHODS: A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program. RESULTS: Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P =0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return. CONCLUSIONS: Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.

Predictors of Clinic Attendance After Community-Based Vision Screening.

Purpose: The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods: A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results: A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions: Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance: This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.

Effect of a Patient Navigator Program to Address Barriers to Eye Care at an Academic Ophthalmology Practice.

Purpose The aim of this study was to determine whether a patient navigator program can address patient-reported barriers to eye care and to understand patient perceptions of a patient navigator program in ophthalmology. Design This is a retrospective cohort study and cross-sectional patient survey. Subjects and Methods A cohort of patients was recruited from a single academic ophthalmology department in the Mid-Atlantic region. Patients included in the study had received referral to the patient navigator program in the first quarter of 2022. Our patient navigator program provided patients with resources to address barriers to care such as transportation and financial assistance. Outcomes of the study included indications for referral, case resolution rate, and patient satisfaction. Results In total, 130 referrals for 125 adult patients were included. The mean ± standard deviation age was 59 ± 17 years, 54 (44%) were male, 77 were white (62%), and 17 patients (14%) were uninsured. Common reasons for referral were transportation (52, 40%), insurance (34, 26%), and financial assistance (18, 14%). Among the 130 cases referred, 127 (98%) received an intervention from the patient navigator, who was able to resolve the referring issue in 90% of cases (117/130). Among 113 patients contacted for a follow-up telephone survey, 56 (50%) responded. Patients rated the program highly at a mean Likert rating of 4.87 out of 5. Moreover, 72% (31/43) of respondents stated their interactions with the patient navigator assisted them with taking care of their eyes. Conclusions A patient navigator program can address barriers to eye care by connecting patients with community resources.