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Social Risk Factors Associated With Microbial Keratitis
Madeleine C Lee1, Emily L Vogt1, Patrice M Hicks1
1Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.
Purpose:
The objective of this study was to identify social risk factors (SRFs) that affect microbial keratitis (MK) care using the Penchansky-Thomas (P-T) health care access framework.
Methods:
This combined retrospective and prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed.
Results:
A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least 1 SRF affecting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, P = 0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared with those not LTFU, had more SRFs (100% vs. 52.4%, P = 0.0001) and reported a greater median number of SRFs (3.0 vs. 1.0, P < 0.0001).
Conclusions:
SRFs affected most patients with MK, most notably accessibility and affordability. Participants with lower income had more SRFs. SRFs are linked to patients being lost to follow-up care.
Insights
Social risk factors significantly impact microbial keratitis care, with accessibility and affordability being key issues. Lower income patients face more barriers, and these factors contribute to patients being lost to follow-up.
Area of Science:
- Ophthalmology
- Public Health
- Health Services Research
Background:
- Microbial keratitis (MK) is a serious eye infection requiring timely and consistent care.
- Social risk factors (SRFs) can create significant barriers to accessing and adhering to healthcare.
- The Penchansky-Thomas (P-T) framework provides a model for understanding healthcare access dimensions.
Purpose of the Study:
- To identify social risk factors (SRFs) impacting microbial keratitis (MK) care.
- To analyze these SRFs using the Penchansky-Thomas (P-T) health care access framework.
- To explore the association between SRFs and patient outcomes, including loss to follow-up.
Main Methods:
- A combined retrospective and prospective cohort study of 100 newly diagnosed MK patients.
- Data collection via in-person interviews and chart reviews to identify SRFs.
- Categorization of SRFs into P-T framework domains and statistical analysis of demographic differences and impact on follow-up.
Main Results:
- 60% of MK patients reported at least one SRF affecting their care.
- Accessibility (49%) and distance to appointments (45%) were the most reported barriers.
- Patients with lower incomes reported more SRFs, and a higher prevalence of SRFs was associated with being lost to follow-up (100% vs. 52.4%).
Conclusions:
- Social risk factors, particularly related to accessibility and affordability, affect the majority of patients with microbial keratitis.
- Lower socioeconomic status is linked to a greater burden of SRFs.
- SRFs are a significant predictor of patients being lost to follow-up care, highlighting a critical gap in MK management.
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