Cost and Effectiveness of an Eye Care Adherence Program for Philadelphia Children with Significant Visual Impairment

Abstract

The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.

Challenges of Eye Health Care in Children and Strategies to Improve Treatment Uptake: A Qualitative Study from the Perspective of Eye Care Professionals in the UK

“…This would require additional administrative support to assist with contacting parents and its cost-effectiveness needs to be evaluated. Nonetheless, direct telephone follow-up could help parents navigate the eye care system, leading to increased willingness to access care and engage with treatments ( Pizzi et al 2015 ; Neville et al 2015 ). If proven beneficial, specific recommendations on direct outreach to patients could be incorporated into guidelines for non-attenders ( Arai et al 2015 ).…”

Vision screening in school children from low-income areas of Sao Paulo city: Frequency and causes of visual impairment and blindness

“…2,3 However, many children who are referred to further evaluation with an ophthalmologist often do not follow the recommendations due to a variety of factors as lack of communication, awareness, perceived importance, and conflict of commitments with scheduling. 4 In that sense, new models have been developed focusing not only on screening but also delivering the follow-up eye care through school, especially in low-income areas where access to eye care is limited. [5][6][7] Precise estimations on childhood prevalence of visual impairment and blindness are challenging due to the methodological difficulties from rare conditions studies.…”

Increasing Screening Follow-Up for Vulnerable Children: A Partnership with School Nurses

“…Although accurate rates of follow-up and treatment after a failed school vision test are not readily available, reported follow-up and treatment rates range between 5% and 18% [6,25,26]. Many students referred for follow-up, especially minority and urban youth and children from low socio-economic status, may not receive the care they need due to multiple reasons, including lack of understanding on parents’ part, parental unawareness of results, miscommunication and lack of clarity in communicating screening results, delay in administering follow-up care, financial problems, lack of insurance, social and family issues such as inability to take time off from work, logistical problems such as scheduling issues and perceptual barriers of parents, parental mistrust of the school nurses, and parental misunderstanding of follow-up procedures [6].…”

“…Many students referred for follow-up, especially minority and urban youth and children from low socio-economic status, may not receive the care they need due to multiple reasons, including lack of understanding on parents’ part, parental unawareness of results, miscommunication and lack of clarity in communicating screening results, delay in administering follow-up care, financial problems, lack of insurance, social and family issues such as inability to take time off from work, logistical problems such as scheduling issues and perceptual barriers of parents, parental mistrust of the school nurses, and parental misunderstanding of follow-up procedures [6]. Other barriers include transportation cost difficulty, access to transportation, payment difficulty, lack of commitment, and lack of means of communication [26]. …”

“…The school nurses involved in the follow-up reported high satisfaction with the program due to its simpler logistics, convenience and effective use of their time [25]. Other studies reported successful follow-up and treatment of vision problems through community outreach programs in inner city areas [27] and social worker intervention [26]. …”