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Chen X, Zhao Y, Zhang A, Zhou Y, Li M, Cheng X, Zhao Y, Yang S, Zhang Z, Li X. Epidemiological variations and trends in glaucoma burden in the Belt and Road countries. BMC Ophthalmol 2024; 24:195. [PMID: 38664615 PMCID: PMC11046886 DOI: 10.1186/s12886-024-03464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Analyzing the glaucoma burden in "Belt and Road" (B&R) countries based on age, gender, and risk factors from 1990 to 2019 in order to provide evidence for future prevention strategies. METHODS We applied global burden of disease(GBD) 2019 to compare glaucoma prevalence and Years lived with disabilities (YLDs) from 1990 to 2019 in the B&R countries. Trends of disease burden between 1990 and 2019 were evaluated using the average annual percent change and the 95% uncertainty interval (UI) were reported. RESULTS From 1990 to 2019, most B&R countries showed a downward trend in age-standardized prevalence and YLDs (all P < 0.05). Additionally, only the age-standardized YLDs in males of Pakistan has a 0.35% increase (95%CI:0.19,0.50,P < 0.001), and most B&R countries has a decline(all P < 0.05) in age-standardized YLDs in every 5 years age group after 45 years old except for Pakistan(45-79 years and > 85 years), Malaysia(75-84 years), Brunei Darussalam(45-49 years), Afghanistan(70-79 years). Finally, in all Central Asian countries, the age-standardized YLDs due to glaucoma caused by fasting hyperglycemia demonstrated have an increase between 1990 and 2019 (all P < 0.05), but Armenia and Mongolia have a decrease between 2010 and 2019 (all P < 0.05). CONCLUSION The prevalence of glaucoma continues to pose a significant burden across regions, ages, and genders in countries along the "B&R". It is imperative for the "B&R" nations to enhance health cooperation in order to collaboratively tackle the challenges associated with glaucoma.
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Affiliation(s)
- Xiangwu Chen
- Department of Ophthalmology, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Yingxi Zhao
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, 310020, Zhejiang Province, China
| | - Anjing Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200040, China
- Department of Neurorehabilitation Medicine, First Rehabilitation Hospital of Shanghai, Kongjiang Branch, theYangpu District, Shanghai, 200092, China
| | - Yanping Zhou
- Department of Ophthalmology, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Min Li
- Department of Ophthalmology, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Xuelin Cheng
- Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenlin Rd., Xuhui, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Yajun Zhao
- Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenlin Rd., Xuhui, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Shijia Yang
- Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenlin Rd., Xuhui, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Zhaoyu Zhang
- Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenlin Rd., Xuhui, Shanghai, China
- Department of General Practice, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200032, China
| | - Xiaopan Li
- Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, 180 Fenlin Rd., Xuhui, Shanghai, China.
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Owsley C, Swain TA, McGwin G, Nghiem VTH, Register S, Asif IM, Fazio M, Antwi-Adjei EK, Girkin CA, Rhodes LA. Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT): Baseline Results. Am J Ophthalmol 2024; 257:66-75. [PMID: 37683821 DOI: 10.1016/j.ajo.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE To describe baseline results of the Alabama Screening and Intervention for Glaucoma and Eye Health through Telemedicine (AL-SIGHT) for patients at federally qualified health centers (FQHCs). Candidates were persons at risk for glaucoma-associated diseases (GAD) based on age, race/ethnicity, current diagnosis of GAD, family history, and diabetes. DESIGN Baseline screening visit followed by remote diagnosis and referral for follow-up examinations. METHODS Patients presenting to FQHCs who were at least 18 years of age were enrolled and underwent screening for acuity, autorefraction, intraocular pressure, visual field testing, and fundus imaging. Results were transmitted to an ophthalmologist at University of Alabama at Birmingham for diagnosis who made referrals for follow-up; follow-up attendance was noted. Questionnaires assessed participants' perspectives on screening. Primary outcomes were rates of disease detection, referral for follow-up, follow-up attendance, and participant satisfaction. RESULTS Of the 500 participants enrolled (mean age 58 years), 45.6% were African American and 51.6% White. Remote diagnostic evaluation of ocular screening by ophthalmologist revealed 30% GAD, 6.8% diabetic retinopathy, 37.6% cataract, 68.4% refractive error, 9.2% other eye conditions. In all, 47.2% of the participants were referred for follow-up examination and for acuity 20/40 or worse or IOP ≥23 mm Hg in one or both eyes. Follow-up examination attendance was 76.7% for those referred. Participants reported being very satisfied with screening (85.8%) and with the convenience of screening in their primary care clinic (92.2%). CONCLUSIONS The high percentage of patients diagnosed with treatable eye conditions at telemedicine screening suggest these programs in FQHCs can be effective and scalable nationwide. Attendance when referred for follow-up examination was high. Participants welcomed screenings in their communities.
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Affiliation(s)
- Cynthia Owsley
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Thomas A Swain
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Epidemiology (T.A.S., G.M.), School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gerald McGwin
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Epidemiology (T.A.S., G.M.), School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Van Thi Ha Nghiem
- Department of Health Policy and Organization (V.T.H.N.), School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shilpa Register
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Irfan M Asif
- Department of Family and Community Medicine (I.M.A.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Massimo Fazio
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ellen K Antwi-Adjei
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Optometry (E.K.A.-A.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsay A Rhodes
- From the Department of Ophthalmology and Visual Sciences (C.O., T.A.S., G.M., S.R.M.F., E.K.A.-A., C.A.G., L.A.R.), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Andoh JE, Ezekwesili AC, Nwanyanwu K, Elam A. Disparities in Eye Care Access and Utilization: A Narrative Review. Annu Rev Vis Sci 2023; 9:15-37. [PMID: 37254050 DOI: 10.1146/annurev-vision-112122-020934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Agnes C Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela Elam
- Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA;
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Zeng R, LaMattina KC. Follow-Up Adherence After Community Health Vision Screening Programs: A Review of the Literature. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e223-e231. [PMID: 37795383 PMCID: PMC10547536 DOI: 10.1055/s-0043-1771354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2023] [Indexed: 10/06/2023]
Abstract
Objective Although the purpose of community eye screening programs is to reduce health care disparities, the effectiveness of these programs is limited by the follow-up adherence of their participants. The aim of this review is to investigate factors that may promote or hinder participants from attending follow-up ophthalmological exams after community eye screenings and identify interventions to increase follow-up rates. Methods For literature review, PubMed, Web of Science, Embase, Proquest/Global Health Library, and Google Scholar databases were searched to identify studies of community eye screenings published between January 2000 and May 2023. Data from these articles were analyzed to identify barriers and facilitators of follow-up adherence after community eye screenings in the United States and to examine strategies used to increase follow-up rates. Only published manuscripts were included. We excluded studies of school screenings and clinic-based screenings. Results A total of 28 articles were included. Follow-up rates ranged from 12.5 to 89%. Nineteen articles reviewed facilitators and barriers to follow-up. Eighteen articles were non interventional and seven (see Table 1 and 2 , respectively) articles described interventions that were tested to improve follow-up rates after screening. Interventions included prescheduled appointments, transportation assistance, patient education, and patient navigators. Conclusion Several interventions are promising to increase follow-up adherence in community eye screenings, but more evidence is needed. Future research should focus on randomized trials of isolated interventions to improve follow-up adherence of disadvantaged populations, although this may be limited given ethical considerations and documented lack of follow-up after screening.
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Affiliation(s)
- Rebecca Zeng
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Kara C. LaMattina
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
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Staropoli PC, Lee RK, Kroger ZA, Somohano K, Feldman M, Verriotto JD, Aldahan A, Rosa PR, Feuer WJ, Zheng DD, Lee DJ, Lam BL. Analysis of Socioeconomic Factors Affecting Follow-Up in a Glaucoma Screening Program. Clin Ophthalmol 2022; 15:4855-4863. [PMID: 35002221 PMCID: PMC8721521 DOI: 10.2147/opth.s346443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine what socioeconomic factors affect follow-up in a glaucoma screening program. Patients and Methods This was a retrospective cohort study of six health fairs in South Florida from October 2012 to March 2013 among socially and economically disadvantaged populations. Visual acuity (VA), intraocular pressure (IOP), cup-to-disc ratio (CDR), and visual field testing were obtained to identify glaucoma suspects. Glaucoma suspects were defined as having intraocular pressure ≥24 mm Hg, cup-to-disc ratio of ≥0.6 in either eye, or glaucomatous defects on visual field testing. In July 2015, telephone surveys were administered to assess follow up and socioeconomic factors. Results Seventy-two out of 144 (50%) glaucoma suspects responded to the survey and were included in the analysis. Of the 72 respondents, average age was 52.8 years old and 65% were female. The most common race was African American (69%) and ethnicity was Haitian (51%). Glaucoma suspects who followed up were significantly more likely to have health insurance compared to those who did not follow up (74% vs 43%, p = 0.014). No significant difference in follow-up based on age (p = 0.125), education (p = 0.151), gender (p = 0.48), or ethnicity (p = 0.707) was identified. Of the 30 respondents, who did not follow up, the most common reasons were "no insurance" (57%, 17/30) and "not worried" (33%, 10/30). Conclusion Insurance was the main socioeconomic factor in determining whether glaucoma suspects followed up after community health screenings. Streamlining social services could increase clinical access of glaucoma suspects.
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Affiliation(s)
- Patrick C Staropoli
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Richard K Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zachary A Kroger
- Ophthalmology Department, Baylor College of Medicine, Houston, TX, USA
| | - Karina Somohano
- Ophthalmology Department, New York Presbyterian Hospital, New York, NY, USA
| | - Matthew Feldman
- Neurology Department, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer D Verriotto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adam Aldahan
- Dermatology Department, University of Minnesota, Minneapolis, MN, USA
| | - Potyra R Rosa
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D Diane Zheng
- Department of Public Health Sciences, University Miami School of Medicine, Miami, FL, USA
| | - David J Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Public Health Sciences, University Miami School of Medicine, Miami, FL, USA
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Hamm LM, Yashadhana A, Burn H, Black J, Grey C, Harwood M, Peiris-John R, Burton MJ, Evans JR, Ramke J. Interventions to promote access to eyecare for non-dominant ethnic groups in high-income countries: a scoping review. BMJ Glob Health 2021; 6:e006188. [PMID: 34493531 PMCID: PMC8424858 DOI: 10.1136/bmjgh-2021-006188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE People who are distinct from the dominant ethnic group within a country can experience a variety of barriers to accessing eyecare services. We conducted a scoping review to map published interventions aimed at improving access to eyecare for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS We searched MEDLINE, Embase and Global Health for studies that described an intervention to promote access to eyecare for the target population. Two authors independently screened titles and abstracts followed by review of the full text of potentially relevant sources. For included studies, data extraction was carried out independently by two authors. Findings were summarised using a combination of descriptive statistics and thematic analysis. RESULTS We screened 5220 titles/abstracts, of which 82 reports describing 67 studies met the inclusion criteria. Most studies were conducted in the USA (90%), attempted to improve access for Black (48%) or Latinx (28%) communities at-risk for diabetic retinopathy (42%) and glaucoma (18%). Only 30% included the target population in the design of the intervention; those that did tended to be larger, collaborative initiatives, which addressed both patient and provider components of access. Forty-eight studies (72%) evaluated whether an intervention changed an outcome measure. Among these, attendance at a follow-up eye examination after screening was the most common (n=20/48, 42%), and directly supporting patients to overcome barriers to attendance was reported as the most effective approach. Building relationships between patients and providers, running coordinated, longitudinal initiatives and supporting reduction of root causes for inequity (education and economic) were key themes highlighted for success. CONCLUSION Although research evaluating interventions for non-dominant, non-Indigenous ethnic groups exist, key gaps remain. In particular, the paucity of relevant studies outside the USA needs to be addressed, and target communities need to be involved in the design and implementation of interventions more frequently.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Aryati Yashadhana
- Centre for Health Equity Training Research & Evaluation, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Performance Improvement, Auckland District Health Board, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Ballouz D, Cho J, Woodward MA, Elam AR, Musch DC, Zhang J, Moroi SE, Johnson L, Cederna J, Newman-Casey PA. Facilitators and Barriers to Glaucoma Screening Identified by Key Stakeholders in Underserved Communities: A Community-engaged Research Approach. J Glaucoma 2021; 30:402-409. [PMID: 33273279 PMCID: PMC8084870 DOI: 10.1097/ijg.0000000000001756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/04/2020] [Indexed: 01/08/2023]
Abstract
PRCIS Community-engaged research (CER) enables researchers to identify community-specific barriers and facilitators to program implementation. Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust, and community-specific barriers, such as Language and Convenience/Access, were identified. PURPOSE The aim was to identify the facilitators and barriers to implementing glaucoma screening programs in 2 community clinics. METHODS A concurrent mixed-methods process analysis using CER. Key stakeholders-including patients, providers, and staff members-from 2 community clinics were interviewed using a semistructured interview guide. Interviews had 2 parts: (1) asking patients about community-based facilitators and barriers to implementing glaucoma screening and care and (2) eliciting feedback about a personalized coaching program. The transcripts were coded using Grounded Theory. Number of participants and number of representative citations were counted per theme. The qualitative analysis was coded using Dedoose 8.3.17 (Los Angeles, CA). RESULTS Thematic saturation was reached after coding 12 interviews. 30 participants were interviewed, 13 from Hamilton Clinic (Flint, MI; 8 patients, 5 providers and staff members) and 17 from Hope Clinic (Ypsilanti, MI; 6 patients, 11 providers and staff members). The most commonly cited themes were: Priorities (98 citations, 30 participants), Knowledge (73, 26) Transportation (63, 26), Cost (60, 23), and Convenience/Access (63, 22). Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust were identified alongside community-specific barriers such as Language and Convenience/Access. Participants rated their likelihood to follow up with an ophthalmologist after participating in the personalized coaching program at a mean of 8.83 (on a scale of 1 to 10 with 10 being the most confident). CONCLUSIONS CER enables researchers to identify community-specific barriers and facilitators, allowing more effective program implementation.
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Affiliation(s)
- Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sayoko E Moroi
- Department of Ophthalmology, Ohio State University, Columbus, Ohio
| | | | | | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Goyal A, Richards C, Patel V, Syeda S, Guest JM, Freedman RL, Hall LM, Kim C, Sirajeldin A, Rodriguez T, Arsenault SM, Boss JD, Hughes B, Juzych MS. The Vision Detroit Project: Visual Burden, Barriers, and Access to Eye Care in an Urban Setting. Ophthalmic Epidemiol 2021; 29:13-24. [PMID: 33576279 DOI: 10.1080/09286586.2021.1884264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access.Methods: Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers.Results: Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03-3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often.Conclusions: Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education.
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Affiliation(s)
- Anju Goyal
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Collin Richards
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Vaama Patel
- Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sarah Syeda
- Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - John-Michael Guest
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ryan L Freedman
- Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Leo M Hall
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chaesik Kim
- Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Abdala Sirajeldin
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tannia Rodriguez
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Samantha M Arsenault
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Joseph D Boss
- Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bret Hughes
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mark S Juzych
- Department of Ophthalmology, Visual, and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Ophthalmology, Visual, and Anatomical Sciences, Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
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Schauwecker N, Tolisano AM, Hunter JB. Lost to follow up: Exploring patients who initially fail cochlear implant evaluation. Cochlear Implants Int 2020; 22:1-6. [PMID: 32778010 DOI: 10.1080/14670100.2020.1791460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To explore variables predicting which individuals return for repeat cochlear implantation (CI) evaluation after initially not qualifying. Study design: Retrospective chart review. Setting: University CI program. Patients: Adults undergoing CI evaluation between 2007-2017 who did not meet implantation criteria. Main outcome measures: Demographics, pure tone audiogram (PTA), speech perception testing, and evaluation hearing aids for patients who did and did not pursue subsequent evaluations after failing to qualify. Results: In total, 135 patients failed to qualify for CI, with 37 returning for additional evaluations. 72.9% of returning patients qualified. Repeat evaluations performed >6 months after initial evaluation were no more likely to result in qualification (P = 0.647). PTA and speech perception testing were no different for patients who did and did not return. With multivariate analysis, quantifying hearing impairment by speech perception scores, no variable predicted return. However, quantifying hearing impairment with WRS, evaluation with personal devices (P = 0.012) and recommendations to return within 6 months (P = 0.001) predicted increased rate of return. Conclusions: The majority who initially do not, will qualify with repeat CI testing. Patients given scheduled time for re-evaluation, and those properly fitted with personal devices return at higher rates. We recommend patients initially not qualifing for CI, return for repeat evaluation within a year.
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Affiliation(s)
| | - Anthony M Tolisano
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacob B Hunter
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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10
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Molto A, Gossec L, Poiraudeau S, Claudepierre P, Soubrier M, Fayet F, Wendling D, Gaudin P, Dernis E, Guis S, Pouplin S, Ruyssen A, Chales G, Mariette X, Beauvais C, Combe B, Flipo RM, Richette P, Chary-Valckenaere I, Saraux A, Sibilia J, Schaeverbeke T, Dougados M. Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one year randomized trial. Semin Arthritis Rheum 2020; 50:701-708. [PMID: 32521324 DOI: 10.1016/j.semarthrit.2020.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. METHODS Prospective, randomized, controlled, open, 12-month trial (NCT02374749). PARTICIPANTS consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). MAIN OUTCOME change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). RESULTS 502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). CONCLUSIONS AND RELEVANCE This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.
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Affiliation(s)
- Anna Molto
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France.
| | - Laure Gossec
- Sorbonne Université, IPLESP, INSERM, Paris France; Pitié Salpêtrière hospital, APHP, Rheumatology department, Paris, France
| | - Serge Poiraudeau
- Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pascal Claudepierre
- Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Françoise Fayet
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Daniel Wendling
- Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France
| | | | | | | | | | - Adeline Ruyssen
- Centre de Rhumatologie, Hôpital Purpan, Toulouse, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Toulouse, France
| | - Gerard Chales
- Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France
| | - Xavier Mariette
- Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France
| | | | - Bernard Combe
- Rheumatology department, CHU Montpellier, Montpellier University, Montpellier, France
| | - René-Marc Flipo
- Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France
| | - Pascal Richette
- Université Paris Diderot, UFR médicale, Paris, France; APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France
| | | | - Alain Saraux
- Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, France
| | - Jean Sibilia
- Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France
| | | | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France
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11
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Zhao D, Guallar E, Bowie JV, Swenor B, Gajwani P, Kanwar N, Friedman DS. Improving Follow-up and Reducing Barriers for Eye Screenings in Communities: The SToP Glaucoma Study. Am J Ophthalmol 2018; 188:19-28. [PMID: 29355481 DOI: 10.1016/j.ajo.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate factors associated with attendance to follow-up ophthalmic care, and to assess the impact of strategies to improve follow-up. DESIGN Cross-sectional study. METHODS This is an ongoing study to develop an eye screening paradigm, focusing on African Americans ≥50 years of age at multiple urban community sites in Baltimore, Maryland. Several strategies were employed aiming to increase follow-up attendance rates. Multivariable logistic regression was used to evaluate the associations between demographic, medical, and ocular factors with follow-up rate. RESULTS The total number of referred patients presenting for a free eye examination (attendance rate) during the first phase, during the second phase, and overall was 686 (55.0%), 199 (63.8%), and 885 (57.0%), respectively. In fully adjusted models, the odds ratio (95% confidence intervals) for attending the follow-up visit was 1.82 (1.19, 2.79) for screening in second phase vs first phase, 0.62 (0.39, 0.99) for screening sites that were 3 to <5 miles vs <1 mile from the hospital, 1.70 (1.12, 2.59) in patients with body mass index ≥ 30 vs < 25 kg/m2, 2.03 (1.28, 3.21) in patients with presenting visual acuity < 20/40 vs ≥ 20/40, and 2.32 (1.24, 4.34) for patients with an abnormal vs normal macula. CONCLUSIONS Obesity, short distance between screening sites and hospital, poor presenting visual acuity in the better eye, and an abnormal macula on fundus photography were associated with increased follow-up rate. Implementation of a combination of strategies effectively increased the follow-up rate. Wider adoption of these strategies in other screening programs has the potential to reduce the burden of visual impairment.
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12
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Zhao D, Guallar E, Gajwani P, Swenor B, Crews J, Saaddine J, Mudie L, Varadaraj V, Friedman DS, Kanwar N, Sosa-Ebert A, Dosto N, Thompson S, Wahl M, Johnson E, Ogega C. Optimizing Glaucoma Screening in High-Risk Population: Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study. Am J Ophthalmol 2017; 180:18-28. [PMID: 28549849 DOI: 10.1016/j.ajo.2017.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To develop, implement, and evaluate a replicable community-based screening intervention designed to improve glaucoma and other eye disease detection and follow-up care in high-risk populations in the United States. We present the design of the study and describe the findings of the first year of the program. DESIGN Prospective study to evaluate screening and follow-up. METHODS This is an ongoing study to develop an eye screening program using trained personnel to identify individuals with ophthalmic needs, focusing on African Americans ≥50 years of age at multiple inner-city community sites in Baltimore, Maryland. The screening examination uses a sequential referral approach and assesses presenting visual acuity (VA), best-corrected VA, digital fundus imaging, visual field testing, and measurement of intraocular pressure. RESULTS We screened 901 individuals between January 2015 and October 2015. Subjects were mostly African Americans (94.9%) with a mean (standard deviation) age of 64.3 (9.9) years. Among them, 356 (39.5%) participants were referred for a definitive eye examination and 107 (11.9%) only needed prescription glasses. The most common reasons for referral were ungradable fundus image (39.3% of those referred), best-corrected VA < 20/40 (14.6%), and ungradable autorefraction (11.8%). Among people referred for definitive examination, 153 (43%) people attended their scheduled examination. The most common diagnoses at the definitive examination were glaucoma and cataract (51% and 40%, respectively). CONCLUSIONS A large proportion of individuals screened required ophthalmic services, particularly those who were older and less well educated. To reach and encourage these individuals to attend screenings and follow-up examinations, programs could develop innovative strategies and approaches.
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13
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Hark LA, Johnson DM, Berardi G, Patel NS, Zeng L, Dai Y, Mayro EL, Waisbourd M, Katz LJ. A randomized, controlled trial to test the effectiveness of a glaucoma patient navigator to improve appointment adherence. Patient Prefer Adherence 2016; 10:1739-48. [PMID: 27660423 PMCID: PMC5019463 DOI: 10.2147/ppa.s108391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Patients 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 METHODS Patients 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. RESULTS A 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). CONCLUSION Help 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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Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
- Correspondence: Lisa A Hark, Department of Research, Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA, Tel +1 215 928 3045, Fax +1 215 928 9085, Email
| | - Deiana M Johnson
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Giuliana Berardi
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Neal S Patel
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Lichuan Zeng
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
| | | | - L Jay Katz
- Wills Eye Hospital Glaucoma Research Center, Philadelphia, PA, USA
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