Trends in low vision service utilisation: A retrospective study based on general population healthcare claims

Abstract

To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands. Methods: A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio-demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time.Results: A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio-economic status and lived in urban areas (68%). Between 2015-2018, significant downward trends were found for treatment with intravitreal injections and lens-related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time. Conclusion:The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens-related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non-users further.

Big data study using health insurance claims to predict multidisciplinary low vision service uptake

“…Our results also revealed that treatment with intravitreal injections and having cataract surgery lowered the odds of receiving multidisciplinary low vision services, which is in line with our previous qualitative study in which we found that patients with wet macular degeneration treated with intravitreal injections often refuse multidisciplinary low vision service referral because of wanting to await the treatment effect 6 . Furthermore, it has been suggested that treatment with intravitreal injections and cataract surgery might lower multidisciplinary low vision service needs in patients due to a positive treatment effect 13 . Higher costs for ophthalmic encounters lowered the odds for multidisciplinary low vision service uptake, which might be explained by ongoing treatment of patients including diagnostic scans and thus more contact between patients and their ophthalmologists.…”

“…To predict receiving multidisciplinary low vision services as the dependent variable, we used multivariable logistic regression models with sociodemographic, clinical, and contextual characteristics and other health care utilization as potential predictors. The selection of predictors was based on the literature, clinical expertise from the authors, and insights gained from our previous studies 6–9,13 …”

“…Very few studies have used claims data to investigate barriers and facilitators in the access to low vision services, which makes this study a valuable contribution to the literature in this area. 8,13…”

“…The objective of this study is to investigate which patient characteristics predict receiving low vision services in a high-income country, that is, the Netherlands, based on health care claims data, with a focus on nonprofit multidisciplinary low vision services. Very few studies have used claims data to investigate barriers and facilitators in the access to low vision services, which makes this study a valuable contribution to the literature in this area 8,13 …”

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

“…Furthermore, from an international perspective, different institutions recommend referral to LVS in their clinical practice guidelines for ophthalmologists and optometrists, such as the American Optometric Association (United States) [ 14 ], the Royal College of Ophthalmologists (United Kingdom) [ 15 ], the Low Vision Academy (Italy) [ 16 ] and the Dutch Society of Ophthalmologists (Netherlands) [ 17 ]. Despite these efforts and supporting literature on the benefits of LVS, international studies report underutilization of and lack of access to LVS [ 18 – 21 ]. There seems to be a mismatch between the potential need and the actual uptake of these services.…”