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Factors associated with pediatric ophthalmology follow-up adherence before and during the COVID-19 pandemic
Natan Hekmatjah1, Charis Hoppe Turner1, Yeabsira Mesfin1
1School of Medicine, University of California, San Francisco, San Francisco, California.
Insights
Pediatric eye care follow-up adherence remained stable but low during the COVID-19 pandemic, with over half of children less-adherent. Factors like public insurance and longer follow-up intervals were associated with lower adherence.
Area of Science:
- Ophthalmology
- Pediatric Healthcare
- Public Health
Background:
- Childhood ophthalmology follow-up was poor before the COVID-19 pandemic.
- The pandemic worsened adherence for routine pediatric medical care.
- Limited data exists on pediatric ophthalmology follow-up during COVID-19.
Purpose of the Study:
- Evaluate the COVID-19 pandemic's effect on pediatric eye care follow-up adherence.
- Identify characteristics linked to follow-up adherence in children with eye disease.
Main Methods:
- Retrospective review of 519 new pediatric patients' medical records (2019 and 2021).
- Patients classified as adherent (within 30 days) or less-adherent (>30 days or no follow-up).
- Single-center study analyzing patient adherence status.
Main Results:
- Follow-up adherence was similar pre- and during the pandemic (49.6% in 2021 vs. 50.4% in 2019).
- Less adherence associated with public insurance, longer recommended follow-up intervals (≥3 months), and care by optometrists.
- Greater adherence seen in patients traveling longer distances (≥177 miles).
Conclusions:
- Childhood eye care follow-up adherence is low but remained stable during the COVID-19 pandemic.
- Over 50% of pediatric patients were less-adherent with follow-up appointments.
- Public insurance and longer follow-up intervals are key factors impacting adherence.
Background:
Studies describe poor follow-up among children in ophthalmology prior to the COVID-19 pandemic. Although the pandemic led to worse adherence for routine medical care in children, little information exists on pediatric ophthalmology follow-up adherence during COVID-19. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on follow-up adherence for children with eye disease, and identified characteristics associated with follow-up adherence.
Methods:
In this single-center study, the medical records of 519 new pediatric (≤18 years of age) patients seen during January, April, August, and December 2019 and 2021 were reviewed retrospectively. Patients were classified into two groups: adherent (patients who followed up within 30 days of recommended appointment time) or less-adherent (patients who followed up >30 days after recommended follow-up or never). Main outcome measure was patient adherence status.
Results:
Follow-up adherence was similar before and during the COVID-19 pandemic (50.4% for 2019 and 49.6% for 2021 [P = 0.40]). Patients that were less likely to be adherent in both univariate and multivariable analyses included those with public insurance (adjusted OR = 0.63 [95% CI, 0.40-1.00]; P = 0.05), and those recommended to follow-up ≥3 months (adjusted OR ≤ 0.10; P < 0.001). In addition, in univariate analysis, those who declined to self-report race (OR = 0.53 [95% CI, 0.29-0.95]; P = 0.04) and those seen by optometrists (OR = 0.42 [95% CI, 0.29-0.60]; P < 0.001) were less likely to be adherent, while patients who traveled ≥177 miles to their provider were more likely to be adherent (OR = 2.88 [95% CI, 1.17-7.55]; P = 0.02).
Conclusions:
Follow-up adherence for childhood eye care was low but remained relatively stable before and during the COVID-19 pandemic; >50% of children were less-adherent.
