Patients miss appointments for many reasons, but a missed appointment is often due to much more than simple forgetfulness or a lack of interest in seeking care. Studies point to factors such as education level, travel distance and employment status as influencing factors not only in follow-up adherence, but also in general compliance with medical care. Identifying risk factors for patient nonadherence to follow-up visits is an important step in ensuring that care is accessible and equitable for all.

Pediatric follow-up adherence is especially important, considering children must rely on adults when they need to attend medical appointments. To identify potential barriers to follow-up adherence and risk factors, a recent study analyzed pediatric glaucoma patients who were seen at the University of Minnesota tertiary care center over a period of eight and half years.

The retrospective cohort study included 176 patients and classified them as adherent (followed up within 30 days), nonadherent (seen between 31 and 80 days) or lost to tertiary follow-up (later than 180 days or never). The researchers found that 54% of patients were classified as adherent, 3% were nonadherent and 43% were lost to tertiary follow-up. Race and distance from the eye clinic were the only variables that significantly impacted adherence.

The researchers described the adherence to follow-up appointments as “alarmingly low” and observed that decreased adherence was associated with non-white patients, as well as increased distance from the clinic.

“Physicians should consider these risk factors when risk-stratifying pediatric glaucoma patients for nonadherence to follow-up,” the researchers recommended. They added that additional studies to identify and reduce biases and barriers to follow-up are needed.

Mikolajczyk B, Greenberg ER, Fuher H, et al. Follow-up adherence and barriers to care for pediatric glaucomas at a tertiary care center. Am J Ophthalmol. August 26, 2020. [Epub ahead of print].