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Published on: March 17, 2023
Cost and effectiveness of an eye care adherence program for Philadelphia children with significant visual impairment
Laura T Pizzi1, Melanie Snitzer2, Tony Amos3
11Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
The Children's Eye Care Adherence Program (CECAP) significantly improved follow-up rates for pediatric eye care, reaching 59.2% adherence. However, the program incurred an additional net cost, highlighting the need for operational efficiencies.
Area of Science:
- Ophthalmology
- Public Health
- Health Services Research
Background:
- Low follow-up rates (<5%) in pediatric vision outreach programs necessitate improved adherence strategies.
- Children's vision care adherence is critical for timely diagnosis and treatment of eye conditions.
- Existing outreach programs lacked effective mechanisms for ensuring patient follow-up.
Purpose of the Study:
- To evaluate the effectiveness and cost of a social worker-led intervention, the Children's Eye Care Adherence Program (CECAP).
- To identify barriers to pediatric eye care follow-up using a conceptual framework and geomapping.
- To determine the impact of CECAP on adherence rates for school children in Philadelphia.
Main Methods:
- A social worker (SW) intervention (CECAP) was implemented to contact families, resolve barriers, and schedule appointments.
- Effectiveness was measured by the percentage of children completing at least one follow-up visit within the recommended timeframe.
- Cost analysis included SW time and program materials; barriers were categorized, and geomapping visualized follow-up rates.
Main Results:
- CECAP achieved a 59.2% follow-up rate (71/120 patients contacted and returned for care).
- Predisposing factors were identified as the primary barrier for patients who did not follow up.
- The program resulted in a net cost of $7983.59, with SW time varying based on patient follow-up.
Conclusions:
- The CECAP intervention significantly enhanced adherence to pediatric eye care appointments.
- Addressing predisposing factors is crucial for improving follow-up rates in pediatric eye care.
- Future efforts should optimize operational efficiencies and target interventions based on follow-up predictors to manage costs.
Abstract:
The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.
