Patient-Related and System-Related Barriers to Glaucoma Follow-up in a County Hospital Population

Lee, Bradford W.; Murakami, Yohko; Duncan, Martin; Kao, Anne; Huang, Jen-Shang; Lin, Shan; Singh, Kuldev

doi:10.1167/iovs.13-12108

Cited by 30 publications

(33 citation statements)

References 25 publications

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“…Previous research has shown that this population is less likely than other patient groups to obtain ocular examinations from an ophthalmologist. [32][33][34][35] The bilateral strategy ensures these patients receive treatment for both eyes when necessary.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Waisbourd

Delvadia

Sembhi

et al. 2016

Journal of Glaucoma

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Section: Discussionmentioning

confidence: 99%

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Waisbourd

Delvadia

Sembhi

et al. 2016

Journal of Glaucoma

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“…Patient wait time results from pressures on provider time, and clinic inefficiencies cause excessive patient wait times, which in turn cause decreased patient satisfaction and barriers to health care. 7,8 Studying clinic workflow is a critical way to gain insight for improvements, but requires large quantities of detailed timing data because of the inherent variability of clinic activities. Time-motion methods can provide data about clinic workflows, but are resource-intensive and prohibitive for large-scale studies.…”

Section: Introductionmentioning

confidence: 99%

Secondary use of electronic health record data for clinical workflow analysis

Hribar

Read-Brown

Goldstein

et al. 2017

Journal of the American Medical Informatics Association

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Objective Outpatient clinics lack guidance for tackling modern efficiency and productivity demands. Workflow studies require large amounts of timing data that are prohibitively expensive to collect through observation or tracking devices. Electronic health records (EHRs) contain a vast amount of timing data – timestamps collected during regular use – that can be mapped to workflow steps. This study validates using EHR timestamp data to predict outpatient ophthalmology clinic workflow timings at Oregon Health and Science University and demonstrates their usefulness in 3 different studies. Materials and Methods Four outpatient ophthalmology clinics were observed to determine their workflows and to time each workflow step. EHR timestamps were mapped to the workflow steps and validated against the observed timings. Results The EHR timestamp analysis produced times that were within 3 min of the observed times for >80% of the appointments. EHR use patterns affected the accuracy of using EHR timestamps to predict workflow times. Discussion EHR timestamps provided a reasonable approximation of workflow and can be used for workflow studies. They can be used to create simulation models, analyze EHR use, and quantify the impact of trainees on workflow. Conclusion The secondary use of EHR timestamp data is a valuable resource for clinical workflow studies. Sample timestamp data files and algorithms for processing them are provided and can be used as a template for more studies in other clinical specialties and settings.

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“… 14 , 15 , 33 Among these, poor follow-up adherence rates were highest among African-Americans, subjects aged 50–80 years, and those diagnosed with advanced stages of glaucoma. 10 – 12 , 15 , 16 One of these studies included: a community-based eye screening program in Baltimore, supported by Hoffberger Family Philanthropies, which targeted a high-risk population similar to that found in our present study. 9 The Hoffberger Program conducted community-based glaucoma screening examinations with a 59% rate of nonadherence to their follow-up visit.…”

Section: Discussionmentioning

confidence: 93%

“… 10 – 13 Other factors associated with poor follow-up adherence, especially among the underserved, include poor health literacy and difficulty navigating the complex healthcare system. 11 , 12 , 14 , 15 In previous studies, patients self-reported that a lack of transportation, difficulty affording copayment, uncertainty of where to find an ophthalmologist, a busy schedule, fear of an ocular diagnosis, and fear of treatment were all barriers to obtaining regular glaucoma-related eye examinations. 3 , 8 , 9 , 11 , 12 , 14 – 16 Research has suggested many strategies to improve patient adherence, but one of the most promising options involves the addition of a dedicated healthcare worker to help and encourage patients to attend eye examination appointments.…”

Section: Introductionmentioning

confidence: 99%

A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence

Hark¹,

Johnson²,

Berardi³

et al. 2016

PPA

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PurposePatients with glaucoma who do not keep their follow-up eye care appointments are at risk for developing more severe ocular disease. The primary aim of the current study was to evaluate whether the use of a patient navigator altered adherence to follow-up eye care appointments in community-versus office-based settings.Patients and methodsPatients diagnosed with a glaucoma-related condition following a comprehensive eye examination at 43 community sites in Philadelphia, PA, USA, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1-year period: Group 1 (G1) received follow-up eye care in a community-based setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; and Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05.ResultsA total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±standard deviation) was 71.2 (±10.0) years. Patients were predominantly female (65.8%, n=102/155) and African-American (71.6%, n=111/155). The mean (±standard deviation) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Appointment adherence, defined as attendance of ≥1 follow-up visit, was 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=33/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11).ConclusionHelp from a patient navigator did not increase the likelihood of keeping ≥1 follow-up appointment in an office-based setting. Adherence rates for follow-up appointments reached close to 70% or above in a self-selected patient population.

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Patient-Related and System-Related Barriers to Glaucoma Follow-up in a County Hospital Population

Cited by 30 publications

References 25 publications

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project

Secondary use of electronic health record data for clinical workflow analysis

A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence

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