Follow-up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center
Follow-up Adherence and Barriers to Care for Pediatric Glaucomas at a Tertiary Care Center
复制标题
三级护理中心儿童青光眼的随访依从性和护理障碍
DOI：
10.1016/j.ajo.2020.08.033
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发表时间：
2021-01-01
影响因子：
4.2
通讯作者：
Areaux, Raymond G., Jr.
中科院分区：
文献类型：
--
作者：
Mikolajczyk, Brian;Greenberg, Ethan R.;Areaux, Raymond G., Jr.
目的：确定在三级保健中心就诊的儿童青光眼患者随访依从性的百分比，并阐明危险因素。设计：回顾性队列研究。方法：在明尼苏达大学就诊超过8.5年的儿童青光眼患者，如果随访时间分别为0-30天、31 - 180天、超过推荐预约时间180天或从未随访，则分为坚持随访、非坚持随访或未进行第三次随访。结果：在分析的176例患者中，95例（54%）患者为黏着性患者（51%为男性，平均[标准差（SD）]年龄：56.1[59.8]个月），5例（3%）患者为非黏着性患者（20%为男性，平均[SD]年龄：25.0[35.8]个月），76例（43%）患者失去第三次随访（55%为男性，平均[SD]年龄：58.9[53.1]个月）。多元logistic回归分析显示，只有种族（白人：优势比为3.58；95%可信区间为1.42-9.05;P = 0.007）和距离眼科诊所（每50英里：优势比为0.79；95%可信区间为0.67-0.92;P = 0.003）显著影响依从性。结论：这是首个关于儿童青光眼患者遵守随访建议的研究。随访预约的坚持率低得惊人，非白种人和距离眼科诊所的距离越远，坚持率越低。医生在对儿童青光眼患者进行随访时应考虑这些风险因素。还需要进一步的研究，通过减少偏见和随访障碍的干预措施来提高依从性。(C) 2020 Elsevier Inc.版权所有。)
PURPOSE: To determine the percent adherence to follow-up for patients with pediatric glaucomas seen at a tertiary care center and to elucidate risk factors.DESIGN: Retrospective cohort study.METHODS: Patients with pediatric glaucomas seen at the University of Minnesota over 8.5 years were classified as adherent, nonadherent, or lost to tertiary follow-up if they followed up within 0-30 days, between 31 and 180 days, or later than 180 days of the recommended appointment time or never, respectively.RESULTS: Of 176 patients analyzed, 95 (54%) were adherent (51% male; mean [standard deviation (SD)] age: 56.1 [59.8] months), 5 (3%) were nonadherent (20% male; mean [SD] age: 25.0 [35.8] months), and 76 (43%) were lost to tertiary follow-up (55% male; mean [SD] age: 58.9 [53.1] months). Multiple logistic regression analysis of variables that were significant in isolation revealed that only race (white: odds ratio, 3.58; 95% confidence interval, 1.42-9.05; P = .007) and distance from the eye clinic (per 50 miles: odds ratio, 0.79; 95% confidence interval, 0.67-0.92; P = .003) significantly impacted adherence.CONCLUSIONS: This is the first study of adherence to follow-up recommendations for patients with pediatric glaucomas. Percent adherence to follow-up appointments was alarmingly low, and decreased adherence was observed with non-white race and increased distance to the eye clinic. Physicians should consider these risk factors when risk-stratifying patients with pediatric glaucomas for nonadherence to follow-up. Additional studies to improve adherence through interventions that reduce biases and barriers to follow-up are needed. ((C) 2020 Elsevier Inc. All rights reserved.)