title: Patient-related and system-related barriers to glaucoma follow-up in a county hospital population.
abstract: OBJECTIVE
  To identify the barriers to glaucoma follow-up and to assess how ethnicity influences the effect of such barriers among patients in a county hospital population.
  
  
  METHODS
  This cross-sectional study included 152 patients, 76 with poor clinic follow-up and 76 with good clinic follow-up, who were recruited at the San Francisco General Hospital glaucoma clinic as part of a case-control study. All subjects were required to be established patients with glaucoma initially seen and diagnosed in the clinic at least 1 year before enrollment. An oral questionnaire pertaining to the barriers to follow-up for glaucoma, as well as patient ethnicity, was administered to all participating subjects. The main outcome measure was the prevalence of significant barriers to follow-up, both overall and stratified by ethnicity.
  
  
  RESULTS
  The most prevalent barriers to follow-up included long clinic waiting times (75%), appointment scheduling difficulties (38%), the effect of other medical or physical comorbidities (29%), and difficulties related to medical interpretation (23%). While several barriers were cited as being important across different ethnicities, Latinos and Asian-Pacific Islanders were particularly affected by difficulties related to medical interpretation (P = 0.0001) and long waiting times in the clinic (P = 0.048).
  
  
  CONCLUSIONS
  Understanding patient-reported barriers to glaucoma follow-up and their variation based on ethnicity may give providers insight as to why patients do not adhere to follow-up recommendations. Strategies to improve follow-up may include reduced clinic wait times, simplified appointment scheduling, and provision of appropriate education and counseling regardless of the patient's native language and ethnicity.
authors: Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
authors: Bradford W
authors: BW
authors: Lee
authors: Yohko
authors: Y
authors: Murakami
authors: Martin T
authors: MT
authors: Duncan
authors: Andrew A
authors: AA
authors: Kao
authors: Jehn-Yu
authors: JY
authors: Huang
authors: Shan
authors: S
authors: Lin
authors: Kuldev
authors: K
authors: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000941:ethics*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D006766:Hospitals, County / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations / Q000941:ethics*; D012189:Retrospective Studies; D012495:San Francisco / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: barriers to follow-up; clinical follow-up; compliance; ethnicity