Confronting Unequal Eye Care in Pennsylvania

An additional aim was added to this project, examining the effect of a telephone intervention on eye care adherence and comparing the efficacy of the intervention to usual care and automated telephone screenings.

Glaucoma is a group of chronic, neurodegenerative diseases of the optic nerve, which leads to an increase in intraocular pressure, gradual changes in the visual field (VF), and progressive vision loss. Glaucomatous vision loss is preventable with proper eye care, including adherence to follow-up appointments and medications. Interventions that improve appointment adherence have the potential to prevent more severe glaucomatous disease. The primary purpose of this study is to determine the efficacy of a multifaceted intervention system, which includes a customized letter and personal telephone outreach, in improving appointment adherence in patients with glaucoma. In order to improve strategies to reduce the rate of appointment non-adherence, shared characteristics of adherent versus non-adherent patients with glaucoma will be identified and compared to patient characteristics in the previous literature. A secondary goal of this study is to analyze the cost-effectiveness of this multifaceted intervention on appointment adherence in patients with glaucoma.

Pt. 1

Inclusion criteria

• African-American race (self-identified)
• Age ≥ 65 years
• Type II Diabetes Mellitus (physician diagnosis) for at least 1 year
• No medical documentation of a DFE by an ophthalmologist or an optometrist within the past 12 months
• Self-report of no DFE within the past 12 months

Exclusion criteria

• Cognitive Impairment (Mini-Mental Status Examination ≤ 24)
• Current clinically significant psychiatric disorder other than depression
• Current medical disorder that limits life expectancy (≤ 12 months) or need for dialysis
• Hearing impairment that precludes research participation

Pt. 2

Inclusion criteria

• Glaucoma (physician diagnosis)
• Scheduled for a follow-up appointment that meets the American Academy of Ophthalmology (AAO) follow-up guidelines
• Attended the Wills Eye Glaucoma Clinic from September 1, 2012 to October 31, 2013
• Age ≥ 21 years old
• Able to understand and speak English

Exclusion criteria

• Diagnosed with a pre-existing medical condition that would preclude the subject from providing reliable and valid data
• Individual was asked to follow-up in less than a month.