Treatment adherence after penetrating corneal transplant in a New Zealand population from 2000 to 2009.
OBJECTIVE
The aim of this study was to evaluate the extent of nonadherence after penetrating keratoplasty in Auckland, New Zealand, over a 10-year period and to identify predictive variables.


METHODS
The New Zealand National Eye Bank records were analyzed for the decade January 1, 2000, to December 31, 2009, inclusive. Variables evaluated included age, gender, ethnicity, proximity to treatment center, level of deprivation, indication for surgery, previous ocular surgery. The number of scheduled appointments offered and attended by each patient was recorded. Outcome measures were appointment compliance and 2-year follow-up completion.


RESULTS
Over the study period, 1055 corneal transplant procedures were identified. After applying exclusion criteria, data from 695 penetrating keratoplasty procedures were included in the study. Two-year follow-up information was available for 91.4%, of which 87.8% survived and 77 (12.1%) failed. Over the study period, 1065 (10.5%) appointments were not attended by patients. Appointment compliance was good in 68.5%, moderate in 26.3%, and poor in 4.9%. Maori and Pacific Island ethnicities were observed to be associated with the lowest level of attendance, whereas European and Indian ethnicities were the most likely to complete follow-up. Rates of appointment compliance were greater at private treatment centers (P = 0.009) and inversely associated with proximity to treatment center (P < 0.0001).


CONCLUSIONS
The rate of nonattendance reported in this study is considerably higher than that observed in other forms of organ transplantation. Both ethnic and socioeconomic factors seem to have a significant influence on attendance compliance. Strategies to improve adherence should take these factors into account.
Department of Ophthalmology, New Zealand National Eye Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Alexandra Z
AZ
Crawford
Thiyaga
T
Krishnan
Sue E
SE
Ormonde
Charles N J
CN
McGhee
Dipika V
DV
Patel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003316:Corneal Diseases / Q000208:ethnology / Q000601:surgery*; D005006:Ethnicity; D005125:Eye Banks / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010349:Patient Compliance / Q000706:statistics & numerical data*; D055815:Young Adult