title: Barriers to Follow-Up and Strategies to Improve Adherence to Appointments for Care of Chronic Eye Diseases.
abstract: OBJECTIVE
  To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence.
  
  
  METHODS
  Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up.
  
  
  RESULTS
  In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%).
  
  
  CONCLUSIONS
  Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.
authors.affiliation: Stanford University School of Medicine Stanford, California, United States.
authors.forename: Atalie C
authors.initials: AC
authors.lastname: Thompson
authors.affiliation: Stanford University School of Medicine Stanford, California, United States.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Thompson
authors.affiliation: Protiviti, New York, New York, United States.
authors.forename: David L
authors.initials: DL
authors.lastname: Young
authors.affiliation: Scripps Clinic, La Jolla, California, United States.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lin
authors.affiliation: Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sanislo
authors.affiliation: Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.
authors.forename: Darius M
authors.initials: DM
authors.lastname: Moshfeghi
authors.affiliation: Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.
authors.forename: Kuldev
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards* / Q000639:trends; D005128:Eye Diseases / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States