Download PDF
CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2021; 13(01): e51-e56
DOI: 10.1055/s-0041-1726288
Research Article

Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

Lauren Hennein 
1   Department of Ophthalmology, University of California San Francisco, San Francisco, California
,
Kimberly A. Spaulding
2   Department of Surgery, University of California San Francisco, San Francisco, California
,
Veronika Karlegan
3   Pre-Health Professions Certificate Program, San Francisco State University, San Francisco, California
,
Ogonna N. Nnamani Silva 
4   School of Medicine, University of California San Francisco, San Francisco, California
,
Alejandra G. de Alba Campomanes
5   Department of Ophthalmology, University of California San Francisco, San Francisco, California
› Author Affiliations Funding This research was supported in part by an unrestricted grant from Research to Prevent Blindness, New York, NY. This study received its financial support from Research to Prevent Blindness http://dx.doi.org/10.13039/100001818.
› Further Information
   Permissions and Reprints

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


Publication History

Received: 04 May 2020

Accepted: 18 November 2020

Article published online:
24 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Tsai J, O'Toole T, Kearney LK. Homelessness as a public mental health and social problem: new knowledge and solutions. Psychol Serv 2017; 14 (02) 113-117
    CrossrefPubMedGoogle Scholar
  • 2 Tsai J. Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Public Health (Oxf) 2018; 40 (01) 65-74
    CrossrefPubMedGoogle Scholar
  • 3 D'Ath PJ, Keywood LJ, Styles EC, Wilson CM. East London's Homeless: a retrospective review of an eye clinic for homeless people. BMC Health Serv Res 2016; 16: 54
    CrossrefPubMedGoogle Scholar
  • 4 Nia J, Wong D, Motamedinia D. The visual acuity and social issues of the homeless population in Toronto. Univ Tor Med J 2003; 84-86
    PubMedGoogle Scholar
  • 5 Maberley DAL, Hollands H, Chang A, Adilman S, Chakraborti B, Kliever G. The prevalence of low vision and blindness in a Canadian inner city. Eye (Lond) 2007; 21 (04) 528-533
    CrossrefPubMedGoogle Scholar
  • 6 People I of M (US) C on HC for H. Health Problems of Homeless People. National Academies Press (US). 1988 . Accessed March 31, 2019 at: https://www.ncbi.nlm.nih.gov/books/NBK218236/
    PubMedGoogle Scholar
  • 7 Ho JH, Chang RJ, Wheeler NC, Lee DA. Ophthalmic disorders among the homeless and nonhomeless in Los Angeles. J Am Optom Assoc 1997; 68 (09) 567-573
    PubMedGoogle Scholar
  • 8 Cumberland PM, Rahi JS. UK Biobank Eye and Vision Consortium. Visual function, social position, and health and life chances: the UK Biobank Study. JAMA Ophthalmol 2016; 134 (09) 959-966
    PubMedGoogle Scholar
  • 9 Braithwaite T, Verlander NQ, Peto T. et al. National Eye Survey of Trinidad and Tobago (NESTT): prevalence, causes and risk factors for presenting vision impairment in adults over 40 years. Br J Ophthalmol 2019; DOI: 10.1136/bjophtha313.
    CrossrefPubMedGoogle Scholar
  • 10 Barnes J, Barnes S, Small C, Otto C, Bennett M. Mobile eye screenings for Hawaii's homeless: results and applications. Clin Optom 2010; 2: 73-77
    CrossrefPubMedGoogle Scholar
  • 11 Chen AJ, Hwang V, Law PY, Stewart JM, Chao DL. Factors associated with non-compliance for diabetic retinopathy follow-up in an urban safety-net hospital. Ophthalmic Epidemiol 2018; 25 (5-6): 443-450
    CrossrefPubMedGoogle Scholar
  • 12 Baggett TP, O'Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health 2010; 100 (07) 1326-1333
    CrossrefPubMedGoogle Scholar
  • 13 Pitz S, Kramann C, Krummenauer F, Pitz A, Trabert G, Pfeiffer N. Is homelessness a risk factor for eye disease? Results of a German screening study. Ophthalmologica 2005; 219 (06) 345-349
    CrossrefPubMedGoogle Scholar
  • 14 Riley AJ, Harding G, Underwood MR, Carter YH. Homelessness: a problem for primary care?. Br J Gen Pract 2003; 53 (491) 473-479
    PubMedGoogle Scholar
  • 15 Lee H, Goodburn A. Developing an integrated strategy to meet homeless families' health needs. Health Visit 1993; 66 (02) 51-53
    PubMedGoogle Scholar
  • 16 Laws D. Homelessness: exploding a modern myth. Interview by Charlotte Alderman. Nurs Stand 1992; 6 (42) 20-21
    PubMedGoogle Scholar
  • 17 Lowry S. Housing and health: health and homelessness. BMJ 1990; 300 (6716): 32-34
    CrossrefPubMedGoogle Scholar
  • 18 Stern R. Homeless people and the NHS: are we discriminating enough?. J Interprof Care 1994; 8: 173-181
    CrossrefPubMedGoogle Scholar
  • 19 Potrykus C. NHS bill: homeless people's health in jeopardy. Health Visit 1990; 63 (06) 186
    PubMedGoogle Scholar
  • 20 Gravelle H, Sutton M. Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy 2001; 6 (01) 6-13
    CrossrefPubMedGoogle Scholar
  • 21 Farrell SJ, Dunn M, Huff J. Psychiatric Outreach Team, Royal Ottawa Health Care Group. Examining health literacy levels in homeless persons and vulnerably housed persons with mental health disorders. Community Ment Health J 2019; DOI: 10.1007/s10597-019-00525-2.
    CrossrefPubMedGoogle Scholar
  • 22 Stacey D, Hill S, McCaffery K, Boland L, Lewis KB, Horvat L. Shared decision making interventions: theoretical and empirical evidence with implications for health literacy. Stud Health Technol Inform 2017; 240: 263-283
    PubMedGoogle Scholar
  • 23 Murakami Y, Lee BW, Duncan M. et al. Racial and ethnic disparities in adherence to glaucoma follow-up visits in a county hospital population. Arch Ophthalmol 2011; 129 (07) 872-878
    CrossrefPubMedGoogle Scholar