Social and Health Care Utilization Factors Associated With Ophthalmic Visit Nonadherence in Glaucoma: An All of Us Study

Abstract

Précis: In a diverse nationwide cohort, lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with health care providers were risk factors for ophthalmic visit nonadherence among glaucoma patients. Purpose: The purpose of this study was to characterize social and health care utilization factors associated with nonadherence with ophthalmic visits among patients with glaucoma. Materials and Methods: Glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey were included and categorized into “visit” and “nonvisit” groups based on visit adherence, defined by self-reported past-year encounters with eyecare providers (yes/no). Data regarding potential factors affecting ophthalmic visit adherence, including past-year medical visits, inabilities to afford health care, and self-reported reasons for delayed care, were extracted. χ2 tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) of visit adherence were analyzed for potential risk factors. Results: Of 5739 glaucoma patients, 861 (15%) were in the nonvisit group. More participants in the visit group reported past-year general doctor/specialist visits (94%/65%; vs. nonvisit group: 89%/49.3%; P<0.05). The nonvisit group reported greater difficulty in affording medical care and learning about medical conditions, and higher rates of delayed/missed health care access for various concerns (P<0.05). Older age (OR=1.02, 1.01–1.03), higher education (OR=1.25, 1.13–1.40), and income level (OR=1.06, 1.01–1.11), not employed for wages (OR=1.28, 1.08–1.53), and higher health care utilization in general medical/specialist visits (ORs range:1.08–1.90) were associated with visit adherence (P<0.05). Visit nonadherence was associated with cost saving on medication (OR=0.62, 0.40–0.97) and delaying/avoiding seeing health care providers because of dissimilarity (OR=0.84, 0.71–0.99) (P<0.05). Conclusions: This study builds on prior literature by identifying potentially modifiable factors associated with visit nonadherence and underutilization of eyecare in glaucoma. These may inform strategies to improve real-world ophthalmic visit adherence and identify patients who might benefit from additional support.