Targeted Telephone-Based Outreach Reconnects Glaucoma Patients With Subspecialty Care

Abstract

Précis: A personalized telephone-based intervention is a costeffective method to return overdue patients with open angle glaucoma (OAG) to subspecialty care. Patients who accepted care overwhelmingly preferred in-person appointments with their provider instead of hybrid visits with telehealth.Purpose: To evaluate the effectiveness of a telephone-based outreach strategy to reconnect OAG patients with subspeciality care.Patients and Methods: Established patients with OAG who were seen before March 1, 2021, but had not returned for care in the following year were contacted via a telephone-based intervention. Patients lost to follow-up (LTF) were offered the option of an inperson visit or a hybrid telehealth visit, which combined in-office testing of vision, intraocular pressure, and optic nerve imaging with a virtual consultation with their glaucoma specialist on a separate date.Results: Of 2727 patients with OAG, 351 (13%) had not returned for recommended care. Outbound calls reached 176 of those patients (50%). Nearly half of all patients contacted readily accepted care, with 71 scheduling in-person appointments (93%) and 5 selecting hybrid visits (6.6%). Medication refills were requested by 17 of those 76 patients, representing nearly a third of the 56 patients who were treated with topical glaucoma medications. Assessment of the program 90 days later found that 40 patients had returned for care, 100 patients had transferred or declined further care, and 40 patients were identified as deceased, lowering the LTF rate to 6.4%, with 15 patients still scheduled for future visits. On the basis of an average call duration of 2.8 ± 2.0 minutes, the added cost of returning a patient with OAG to care by the program was $28.11.Conclusions: Providing targeted outreach by telephone is an effective and cost-efficient strategy to reconnect OAG patients LTF with subspecialty care.

Factors associated with loss to follow‐up in patients with advanced age‐related macular degeneration: A telehealth recall initiative

“…34 This limitation was addressed by conducting a detailed chart review to enhance the accuracy of the clinical classification of each patient identified for outreach. [23][24][25] Despite finding a strong association between age and becoming LTFU, none of the other characteristics investigated here predicted which patients were more likely to be reached or accept a return to eye care when contacted. The definition of LTFU used in this study may also have inadvertently selected patients who faced more serious or insurmountable barriers to returning for care.…”

“…Previous telehealth studies targeting patients with open-angle glaucoma or diabetic retinopathy achieved higher success rates in returning patients to eye care. [22][23][24][25] This may be attributed, in part, to the younger age of patients with those conditions compared to advanced AMD. While the goal was to achieve a higher return rate for in-person eye care, contacting patients, including through a family member or healthcare proxy, fulfils the obligation to provide continued care.…”

“…1 This study sought to identify factors associated with becoming lost to follow-up (LTFU) among patients with advanced AMD, encompassing both wet and dry forms of the disease, and evaluated the effectiveness of reintroducing patients to care through outreach conducted by a telehealth extender. While prior studies have demonstrated that telephone-based outreach reduced the LTFU rate for patients with diabetic retinopathy or open-angle glaucoma, [22][23][24][25] reengaging patients overdue for follow-up care with AMD has not been previously investigated.…”