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Identifying Barriers and Improving Adherence to Follow-up of Childhood Glaucoma in South India
Manju R Pillai1, George Varghese Puthuran1, David S Friedman2
1Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, India.
Insights
Only half of children with glaucoma adhere to follow-up appointments. Lower socioeconomic status and lack of prior surgery are key barriers, but financial aid may improve adherence.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Childhood glaucoma requires consistent follow-up for effective management.
- Adherence to follow-up is crucial for monitoring disease progression and treatment efficacy.
- Predictors and barriers to follow-up in this population are not well understood.
Purpose of the Study:
- To identify predictors and barriers influencing adherence to follow-up care in children with glaucoma.
- To explore strategies for enhancing follow-up adherence in this vulnerable patient group.
Main Methods:
- A cross-sectional study involving caregivers of children diagnosed with glaucoma.
- Data collected via home visits included socioeconomic status, education, and quality of life.
- Adherence was defined as returning within 6 months of the recommended follow-up; logistic regression analyzed associated factors.
Main Results:
- 56% of children adhered to follow-up appointments.
- Higher caregiver education, urban residence, and upper-middle-class status were associated with better adherence.
- Children with prior glaucoma surgery were 3.02 times more likely to adhere to follow-up.
Conclusions:
- Adherence to follow-up in childhood glaucoma is suboptimal, with only half of patients remaining compliant.
- Key risk factors for non-adherence include lack of prior surgery and lower socioeconomic status.
- Financial assistance for travel and medical expenses is a potential strategy to improve long-term follow-up rates.
Objective:
To understand predictors and barriers of adherence to follow-up and identify strategies to improve follow-up in childhood glaucoma.
Design:
Cross-sectional study.
Subjects:
Caregivers of children with glaucoma diagnosed between January 2014 and January 2019 residing within 200 km of the base hospital.
Methods:
Home visits were conducted with consenting caregivers to collect information on socioeconomic status, education, occupation, activities, and quality of life. Caregivers were subsequently invited to bring their affected children to the base hospital for a comprehensive eye evaluation. Adherence was defined as returning within 6 months of the recommended follow-up visit. Logistic regression was used to identify factors associated with adherence.
Main Outcome Measures:
Adherence to follow-up; association of adherence with socioeconomic status, caregiver education, prior glaucoma surgery, and travel-related barriers; perceived facilitators for improving follow-up.
Results:
Of 147 caregivers who were interviewed in their homes, 142 reported to the base hospital with the child and were included in the analysis. Of these, 79 (56%) remained adherent to follow-up. Caregivers of adherent children were more likely to be better educated (68.3% vs. 42.9% having at least high school education; P = 0.018); they were more frequently from urban areas (19% vs. 8%; P = 0.084), and more caregivers belonged to upper middle class (17.7% vs. 6.3%; P = 0.027). Multivariable logistic regression adjusting for these factors showed that children who had undergone glaucoma surgery were 3.02 times more likely (95% confidence interval = 1.21-7.54) to be adherent. Travel distance to the hospital was not associated with adherence. Caregivers reported that cost incentives toward travel and medical expenses would encourage follow-up.
Conclusions:
Only half the children with childhood glaucoma remained adherent to follow-up. Lack of prior surgery followed by lower socioeconomic status were the key risk factors. Financial assistance may help improve long-term follow-up.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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