A Randomized Trial to Improve Adherence to Follow-up Eye Examinations Among People With Glaucoma
ORIGINAL RESEARCH — Volume 18 — May 20, 2021
A telemedicine screening visit was scheduled for 794 participants. Of these, 254 did not show up or cancelled the appointment. A separate 366 participants were walk-ins with no prior appointment. Thus a total of 906 participants were screened; of these, 551 had nonnormal images at the telemedicine screening visit, with 15 of these participants fast-tracked because of high intraocular pressure, 1 of whom declined further participation. 536 participants were invited to attend visit 2, the confirmatory visit. 189 participants did not attend visit 2; 347 did attend, and 17 of these consented to participate in the second phase of the study. A total of 344 participants were randomized: 172 to usual care, and 172 to enhanced care (the intervention). In the usual care group, 66 attended the final visit. In the enhanced care/intervention group 77 attended the final visit.
Flow chart describing the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, indicating participant inclusion, exclusion, and randomization to the usual care group or enhanced intervention group.
A graph shows the percentage of visits attended over time for each of the 2 study groups. At Visit 3 the intervention group had a 74.4% attendance, and the usual care group had a 39.0% attendance. Thereafter the yearly attendance for both groups dropped over years 1, 2, and 3, with attendance in the intervention group of 18.6%, 20.9%, and 20.0% for these 3 years respectively versus attendance in the usual care group of 8.1%, 6.4%, and 4.0% for the same periods.
Adherence to recommended follow-up schedule over time by intervention group. Visit 3 was the initial visit with the community ophthalmologist. Timely adherence to Visit 3 was defined as attendance within 12 months of randomization. Annual adherence in Years 1–3 was defined as having attended all recommended follow-up visits within 13 months based on the recommended follow-up at the visit closest to the beginning of the year.
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