The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes

Abstract

Précis: This study addresses the paucity of literature examining glaucoma patients’ distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments. Purpose: To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. Methods and Participants: Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill’s Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ2, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. Results: In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24–4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t (150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t (197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t (144)=−2.193; P<0.05). Conclusions: Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.

Disparities in Vision Health and Eye Care

“…143 Recent studies of minimally invasive glaucoma surgeries in non-Hispanic and Hispanic Black patients have shown good outcomes with certain minimally invasive glaucoma surgeries procedures. 144e146 Aside from race and ethnicity, potential disparities in rates of procedural glaucoma treatment and follow-up have been identified by age, 147 region, 148 provider type, 148 and distance from provider, 149 among other factors.…”

Increased Distance From the Clinic Leads to Higher Loss to Follow-Up After Pars Plana Vitrectomy in Diabetic Patients

“…In the particular case of the Kittner Eye Center and for this study population, the university's financial assistance program available to uninsured patients may also have made cost less of a barrier to care and thus increased follow-up rates. The previously discussed study by Funk et al 8 of a postsurgical glaucoma patient population which was served by the same clinic suggested insurance and socioeconomic status did affect loss to follow-up. They found that patients with Medicaid insurance were statistically more likely to be lost to follow-up after glaucoma surgery than patients with Medicare plans and also on average lived >12 miles from the clinic further than Medicare patients.…”

“…In this group of postsurgical patients with glaucoma, 20.1% of the study population and 37% of patients living .50 miles from the clinic were lost to follow-up during the 3-month postoperative period. 8 Other studies have shown distance from the clinic to be a challenge for patients with diabetes and other chronic retinal conditions seeking routine ophthalmologic care. [4][5][6][7] Sloan et al 4 found that patients with diabetes living .20 miles from the nearest ophthalmologist were 33% less likely to receive eye examinations during their study follow-up period than patients living closer.…”

“…1–4 Other studies have investigated how these factors affect follow-up rates for patients with other retinal diseases, such as retinal vein occlusion or exudative age-related macular degeneration, which also may require treatment with antivascular endothelial growth factor injections (VEGF) and frequent clinic visits. 5–8 Some studies have shown that increased distance from the clinic represents a significant risk factor for being lost to follow-up 4–7 ; others have shown little effect. 2…”

Factors associated with loss to follow‐up after radiation therapy for head and neck cancer

“…The influence of distance on LTFU may be due to long travel time in addition to appointment time and increased expenses from fuel, food, or lodging. Distance has been noted as an important factor contributing to LTFU in other contexts including bariatric surgery, glaucoma surgery, and HIV 21,22,36,37 . Clinicians should be aware of the challenges in attending appointments for patients who live far away, prioritize open and honest communication, and offer potential resources that may help.…”