Incentive-based eye care scheme enhances tertiary visit compliance in elderly
A novel incentive care scheme (ICS) ─ combining patient education together with social, financial, and logistic support (in the form of transport allowance) ─ was effective at improving compliance of underprivileged elderly people with visual impairment in attending tertiary eye care referrals after community screening, reveals a pilot study.
“[This group of individuals] often do not attend tertiary care, even if significant eye diseases are detected while in the community,” said the researchers led by Dr Marcus Ang from the Singapore National Eye Centre, who noted the high default rates among these individuals.
The study randomized 140 elderly individuals (mean age 66.6 years, 46.4 percent females) with visual impairment in a 1:1 ratio to receive either ICS + usual care or usual care alone (which comprised a standard referral letter as well as advice). [Clin Exp Ophthalmol 2017;doi:10.1111/ceo.13140]
Compliance rate to tertiary eye care attendance ─ the primary endpoint ─ was almost doubled with ICS vs with usual care alone (31.9 percent vs 16.2 percent; p=0.027).
The main reasons reported for defaulting tertiary health care included a lack of time (22 percent vs 14 percent, respectively), patient’s perception that further care was unnecessary (22 percent vs 3 percent), financial difficulty (0 percent vs 6 percent), and health-related barriers (14 percent in both groups).
“The ICS was specifically designed to overcome some of these barriers by first empowering the participants through education and counselling, and second, by providing social support, logistical help and financial assistance,” said Ang and co-authors.
Furthermore, ICS was well received with 88.1 percent of the participants reported being “very satisfied” or “satisfied” with the programme and 95.2 percent saying they would participate in the scheme if it was implemented nationally.
Nonetheless, overall compliance to follow-up tertiary care at 3 months was generally poor in both the ICS and usual care groups (51.4 percent vs 55.9 percent; p=0.906). Main barriers to compliance to follow-up included health issues preventing further attendance (40 percent), difficulties contacting participants (33 percent), and refusal for further care after first visit (27 percent).
Among those who were compliant to the 3-month follow-up visit, both the ICS and the usual care groups saw significant improvements in best-corrected visual acuity (p<0.03) at 3 months from baseline, with more ICS participants experiencing improvements than those receiving usual care (100 percent vs 80 percent; p<0.001).
According to the researchers, the improved visual acuity was mainly attributed to correction of refractive error or management of cataracts.
However, the improved visual acuity did not lead to significant differences between the two groups in Rasch-transformed vision-related quality of life scores.
The researchers acknowledged that the high attrition rates and short follow-up period might have limited the findings on the secondary outcomes. [Optom Vis Sci 2013;90:861-866] Also, due to the small sample size, they were unable to determine factors affecting health-seeking behaviour among the participants.
“A study with a larger sample size, multiple follow-up time points and the inclusion of a cost-effectiveness analysis for provision of on-site primary eye care treatment, such as spectacles, is currently underway,” said Ang and co-authors. “If the result of our larger trial is successful, the long-term goal is to integrate the ICS into the existing healthcare system for vulnerable elderly individuals in the community.”