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Follow-up Rates at a Free Ophthalmology Homeless Clinic

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Posterboard#: B0324

Abstract Number: 5433 - B0324

AuthorBlock: Lauren Hennein1, Kimberly Spaulding2, Veronika Karlegan3, Alejandra de Alba Campomanes1
1Ophthalmology, University of California San Francisco Department of Ophthalmology, San Francisco, California, United States; 2University of California San Francisco, San Francisco, California, United States; 3San Francisco State University, California, United States;

DisclosureBlock: Lauren Hennein, None; Kimberly Spaulding, None; Veronika Karlegan, None; Alejandra de Alba Campomanes, None;

Purpose
To examine follow-up rates and barriers to care for patients referred from a free ophthalmology homeless clinic.

Methods
This retrospective cohort included 68 patients who were evaluated at a free, monthly ophthalmology clinic from September 2017 to 2018 at a local homeless shelter. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a partnering nonprofit organization. Follow-up rates were calculated. Categorical variables were compared with chi-squared testing to determine their association with follow-up rates.

Results
Of the 68 patients, 40 (59%) were referred to a partnering nonprofit organization for free eyeglasses and 17 (25%) were referred to a local county hospital for advanced ophthalmologic care. Of those referred, 7 patients (41%) presented to their county hospital appointment while 14 patients (35%) presented to the nonprofit organization for free eyeglasses. Fifty-two percent of patients with a pre-established primary care provider (PCP) presented to their referral appointment while only 20% of patients without a PCP presented to their appointment (p = 0.025). Nineteen of the 43 patients (44%) who completed at least a high school education presented to their referral appointment while all patients without a high school diploma failed to present to their appointment (p = 0.037). Vision-threatening conditions identified at the homeless clinic did not significantly affect follow-up rates: patients with diabetic and hypertensive retinopathy, afferent pupillary defects, glaucoma/glaucoma suspect, and visual field defects were not more likely to present to their referral appointment at the county hospital compared to those without vision-threatening conditions (p = 0.79).

Conclusions
In the current literature, there is limited knowledge of follow-up rates for ophthalmologic diseases and refractive error among those without permanent housing. In our study, less than half of referred patients presented to their appointments. Barriers to presentation included no PCP and lower educational status. There was no improvement in follow-up rates among those being referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be beneficial, particularly in those not looped into the healthcare system and those of lower educational attainment.

Layman Abstract (optional): Provide a 50-200 word description of your work that non-scientists can understand. Describe the big picture and the implications of your findings, not the study itself and the associated details.
Blindness and other eye conditions amongst the homeless population are devastating and makes them particularly vulnerable. Many homeless patients require ophthalmologic care, yet care is expensive, wait times to see an ophthalmologist are long, and follow-up rates are typically low.

The free ophthalmology clinic was created to bridge some of these gaps by regularly providing ophthalmologic care, referrals for more advanced care, and access to free eyeglasses if indicated. However, there is limited knowledge regarding the prevalence of ophthalmologic diseases, follow-up rates for the treatment of these diseases, and barriers to care among those without permanent housing.

In our study, patients with significant eye conditions that warranted advanced management were high: 59% were referred for spectacles and 25% were referred to the local county hospital. We also found that less than half of referred patients actually presented to their appointments. Further, there was no improvement in follow-up rates among those being referred for vision-threatening conditions. Barriers to presentation included patients without a primary care provider and lower educational status. Our study highlights the need to identify interventions, such as health coaching, that educate patients on the effects of their vision-threatening conditions, especially in those not currently looped into the healthcare system and those with lower educational attainment.