title: Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care.
abstract: BACKGROUND
  Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma.
  
  
  OBJECTIVE
  The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence.
  
  
  METHODS
  This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios.
  
  
  RESULTS
  Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56.
  
  
  CONCLUSIONS
  A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
authors.affiliation: Thomas Jefferson University, 901 Walnut Street, Room 911, Philadelphia, PA, 19107, USA. laura.pizzi@jefferson.edu.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Judie
authors.initials: J
authors.lastname: Tran
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Anousheh
authors.initials: A
authors.lastname: Shafa
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Waisbourd
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hark
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Ann P
authors.initials: AP
authors.lastname: Murchison
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Yang
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA.
authors.forename: Eileen L
authors.initials: EL
authors.lastname: Mayro
authors.affiliation: Wills Eye Hospital, 840 Walnut Street Suite 1500, Philadelphia, PA, USA.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Haller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003362:Cost-Benefit Analysis; D005260:Female; D005901:Glaucoma / Q000191:economics* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D017010:Reminder Systems / Q000191:economics*; D013689:Telephone; D014481:United States