Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego.
Health Department of Biomedical Informatics, University of California, San Diego.
J Glaucoma. 2023 Dec 1;32(12):1029-1037. doi: 10.1097/IJG.0000000000002300. Epub 2023 Aug 29.
In a diverse nationwide cohort, lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with health care providers were risk factors for ophthalmic visit nonadherence among glaucoma patients.
The purpose of this study was to characterize social and health care utilization factors associated with nonadherence with ophthalmic visits among patients with glaucoma.
Glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey were included and categorized into "visit" and "nonvisit" groups based on visit adherence, defined by self-reported past-year encounters with eyecare providers (yes/no). Data regarding potential factors affecting ophthalmic visit adherence, including past-year medical visits, inabilities to afford health care, and self-reported reasons for delayed care, were extracted. χ 2 tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) of visit adherence were analyzed for potential risk factors.
Of 5739 glaucoma patients, 861 (15%) were in the nonvisit group. More participants in the visit group reported past-year general doctor/specialist visits (94%/65%; vs. nonvisit group: 89%/49.3%; P <0.05). The nonvisit group reported greater difficulty in affording medical care and learning about medical conditions, and higher rates of delayed/missed health care access for various concerns ( P <0.05). Older age (OR=1.02, 1.01-1.03), higher education (OR=1.25, 1.13-1.40), and income level (OR=1.06, 1.01-1.11), not employed for wages (OR=1.28, 1.08-1.53), and higher health care utilization in general medical/specialist visits (ORs range:1.08-1.90) were associated with visit adherence ( P <0.05). Visit nonadherence was associated with cost saving on medication (OR=0.62, 0.40-0.97) and delaying/avoiding seeing health care providers because of dissimilarity (OR=0.84, 0.71-0.99) ( P <0.05).
This study builds on prior literature by identifying potentially modifiable factors associated with visit nonadherence and underutilization of eyecare in glaucoma. These may inform strategies to improve real-world ophthalmic visit adherence and identify patients who might benefit from additional support.
在一个多样化的全国性队列中，较低的教育和收入水平、药物节省成本、过去一年医疗/专科就诊次数较少以及对与医疗保健提供者的差异的担忧，是青光眼患者眼科就诊不依从的危险因素。
本研究旨在描述与青光眼患者眼科就诊不依从相关的社会和医疗保健利用因素。
纳入了 All of Us 数据库中完成医疗保健获取和利用调查的青光眼患者，并根据过去一年与眼科保健提供者的就诊情况（有/无），将患者分为“就诊”和“未就诊”组。提取了可能影响眼科就诊依从性的潜在因素的数据，包括过去一年的医疗就诊情况、无法负担医疗保健费用以及自我报告的延迟治疗原因。采用卡方检验和 logistic 回归比较两组。分析就诊依从性的潜在危险因素的就诊率比值比（OR）。
在 5739 名青光眼患者中，有 861 名（15%）患者未就诊。就诊组报告过去一年普通医生/专科医生就诊的比例更高（94%/65%；与未就诊组相比：89%/49.3%；P<0.05）。未就诊组报告在负担医疗保健费用和了解病情方面存在更大困难，并且由于各种原因，延迟/错过医疗保健服务的比例更高（P<0.05）。年龄较大（OR=1.02，1.01-1.03）、较高的教育程度（OR=1.25，1.13-1.40）和收入水平（OR=1.06，1.01-1.11）、非工资就业（OR=1.28，1.08-1.53）和一般医疗/专科就诊次数较高（OR 范围：1.08-1.90）与就诊依从性相关（P<0.05）。药物节省成本（OR=0.62，0.40-0.97）和因差异而延迟/避免看卫生保健提供者（OR=0.84，0.71-0.99）与就诊不依从相关（P<0.05）。
本研究通过确定与青光眼就诊不依从和眼科保健利用不足相关的潜在可改变因素，扩展了先前的文献。这些可能为改善现实世界中的眼科就诊依从性和识别可能受益于额外支持的患者提供信息。
