与老年相关性黄斑变性患者失访相关的因素：远程医疗召回计划。

Factors associated with loss to follow-up in patients with advanced age-related macular degeneration: A telehealth recall initiative.

机构信息

Lahey Department of Surgery, Division of Ophthalmology, UMass Chan Medical School, University of Massachusetts, Burlington, Massachusetts, USA.

Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA.

出版信息

Ophthalmic Physiol Opt. 2024 May;44(3):626-633. doi: 10.1111/opo.13298. Epub 2024 Feb 29.

DOI:10.1111/opo.13298

PMID:38425149

Abstract

INTRODUCTION

Patients with advanced age-related macular degeneration (AMD) frequently experience loss to follow-up (LTFU), heightening the risk of vision loss from treatment delays. This study aimed to identify factors contributing to LTFU in patients with advanced AMD and assess the effectiveness of telephone-based outreach in reconnecting them with eye care.

METHODS

A custom reporting tool identified patients with advanced AMD who had not returned for eye care between 31 October 2021 and 1 November 2022. Potentially LTFU patients were enrolled in a telephone outreach programme conducted by a telehealth extender to encourage their return for care. Linear regression analysis identified factors associated with being LTFU and likelihood of accepting care post-outreach.

RESULTS

Out of 1269 patients with advanced AMD, 105 (8.3%) did not return for recommended eye care. Patients LTFU were generally older (89.2 ± 8.9 years vs. 87.2 ± 8.5 years, p = 0.02) and lived farther from the clinic (25 ± 43 miles vs. 17 ± 30 miles, p = 0.009). They also had a higher rate of advanced dry AMD (26.7% vs. 18.5%, p = 0.04) and experienced worse vision in both their better-seeing (0.683 logMAR vs. 0.566 logMAR, p = 0.03) and worse-seeing (1.388 logMAR vs. 1.235 logMAR, p = 0.04) eyes. Outreach by a telehealth extender reached 62 patients (59%), 43 through family members or healthcare proxies. Half of the cases where a proxy was contacted revealed that the patient in question had died. Among those contacted directly, one third expressed willingness to resume eye care (20 patients), with 11 scheduling appointments (55%). Despite only two patients returning for in-person eye care through the intervention, the LTFU rate halved to 4.4% by accounting for those patients who no longer needed eye care at the practice.

CONCLUSIONS

There is a substantial risk that older patients with advanced AMD will become LTFU. Targeted telephone outreach can provide a pathway for vulnerable patients to return to care.

摘要

简介

患有晚期年龄相关性黄斑变性（AMD）的患者经常出现失访（LTFU），这增加了因治疗延误导致视力丧失的风险。本研究旨在确定导致晚期 AMD 患者 LTFU 的因素，并评估基于电话的外展在重新连接他们与眼科护理方面的效果。

方法

一个定制的报告工具确定了 2021 年 10 月 31 日至 2022 年 11 月 1 日期间未返回进行眼部护理的晚期 AMD 患者。潜在的失访患者被纳入由远程医疗扩展器进行的电话外展计划，以鼓励他们返回进行护理。线性回归分析确定了与 LTFU 相关的因素以及接受外展后护理的可能性。

结果

在 1269 名晚期 AMD 患者中，有 105 名（8.3%）未返回接受推荐的眼部护理。失访患者通常年龄更大（89.2±8.9 岁与 87.2±8.5 岁，p=0.02），居住距离诊所更远（25±43 英里与 17±30 英里，p=0.009）。他们还患有更高比例的晚期干性 AMD（26.7%与 18.5%，p=0.04），并且在他们视力较好的眼睛中视力更差（0.683 logMAR 与 0.566 logMAR，p=0.03）和视力较差的眼睛中视力更差（1.388 logMAR 与 1.235 logMAR，p=0.04）。远程医疗扩展器的外展联系到了 62 名患者（59%），其中 43 名是通过家庭成员或医疗代理人联系的。联系到的代理人中有一半表明患者已死亡。在直接联系的患者中，三分之一表示愿意恢复眼部护理（20 名患者），其中 11 名安排了预约（55%）。尽管通过干预措施只有两名患者亲自到诊所进行了眼部护理，但考虑到那些不再需要在诊所进行眼部护理的患者，LTFU 率减半至 4.4%。