Abstract
Objective Eye health among the homeless community is important, as poor vision makes this population
vulnerable and adds significantly to the social and health burden. There is limited
knowledge on patient follow-up rates for their eye conditions and barriers to accessing
care in this population. The purpose of this retrospective chart review study is to
examine follow-up rates and barriers to care for patients referred from a free, medical-student
run ophthalmology clinic at a homeless shelter.
Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September
2018 were included; no patients were excluded. If indicated, patients were referred
for advanced ophthalmologic care at a local county hospital and free eyeglasses at
a nonprofit organization. Primary outcomes were follow-up rates at the county hospital
and nonprofit organization. Secondary outcomes included prespecified baseline variables
hypothesized to be associated with follow-up rates. These categorical variables were
compared with Chi-square testing to determine their association with follow-up rates.
The hypothesis being tested was formulated before data collection.
Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients
were referred for free eyeglasses and 17 to the county hospital. Of those referred,
14 patients presented for free eyeglasses and 7 presented to the county hospital.
About 79% of patients with a pre-established primary care provider presented to their
appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients
without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect
follow-up rates (p = 0.79).
Conclusion Less than half of referred patients in our study presented to their appointments.
Barriers to presentation included no primary care provider and lower educational status,
with no improvement in follow-up rates among those 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 warranted, particularly
for those not looped into the health care system and those of lower educational attainment.
Keywords
homelessness - homeless shelter - free eye clinic - follow-up - medical student education
