Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India.
OBJECTIVE
To determine predictors of and reasons for poor longitudinal glaucoma follow-up in South India.


METHODS
This 1-to-1, matched, case-control study enrolled 300 patients with established glaucoma. We defined cases (poor follow-up) and controls (good follow-up) based on number of and maximum interval between glaucoma follow-up visits attended in the preceding year. We collected data by oral questionnaire and used stepwise multivariate logistic regression to calculate odds ratios (ORs) for poor follow-up.


RESULTS
Adjusting for age and sex, independent predictors of poor follow-up included lack of formal education (adjusted OR, 4.13; 95% confidence interval [CI], 1.44-11.90), no use of prescribed glaucoma medications (adjusted OR, 2.17; 95% CI, 1.06-4.43), and belief that follow-up is less important if one uses glaucoma medications and has no noticeable visual changes (adjusted OR, 10.59; 95% CI, 3.74-29.97). Age, sex, and disease severity were not significant predictors. The most prevalent barriers to follow-up were belief that there was no problem with one's eyes (44.4%) and lack of escort (19.7%).


CONCLUSIONS
Knowing predictors of poor follow-up can help identify patients who need individualized strategies to improve follow-up. Because believing one's eyes are problem-free and lacking escorts are significant barriers to follow-up, novel strategies in patient education (eg, intensive counseling, audiovisual aides, and patient support groups) and escort provision may improve longitudinal glaucoma follow-up and disease management.
Department of Ophthalmology, Stanford University, Palo Alto, CA 94306, USA. bradford.lee@stanford.edu
Bradford W
BW
Lee
Parthasarathi
P
Sathyan
Rajesh K
RK
John
Kuldev
K
Singh
Alan L
AL
Robin
D016022:Case-Control Studies; D016001:Confidence Intervals; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D006297:Health Services Accessibility / Q000592:standards* / Q000639:trends; D006801:Humans; D007194:India; D007429:Intraocular Pressure / Q000502:physiology; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D015999:Multivariate Analysis; D011182:Postoperative Care; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014065:Tonometry, Ocular / Q000706:statistics & numerical data*