A study presented at the 128th Annual American Academy of Ophthalmology (AAO) Meeting showed that multiple social risk factors of healthcare access impacted healthcare access among patients with microbial keratitis (MK), particularly for those with lower income.
“Understanding social risk factors is the first step to improving access to care for patients with MK,” said a team of investigators led by Madeleine C. Lee, BS, associated with the Department of Ophthalmology and Visual Sciences at the University of Michigan.
MK currently affects approximately 1.5 to 2 million patients worldwide, with social risk factors affecting a patient’s ability to access care. The Penchansky and Thomas (P-T) framework identifies these factors that affect the ability for patients to receive MK care. They include affordability, availability, accessibility, awareness, accommodation or adequacy and acceptability.
Investigators sought to identify the social risk factors using this framework. Eligible patients were recruited from a prospective cohort at the University of Michigan between August 2020 and December 2023 and had a new diagnosis of clinically significant MK. These patients were followed up for up to 90 days. Data were collected using prospective interviews in conjunction with a retrospective chart review. These factors were assessed as both categorical—meaning no social risk factors or one or more factors—and continuous measured, defined as the number of risk factors.
Patients excluded from the study were younger than 15 years of age, had previous incisional corneal surgery, were currently pregnant or incarcerated and/or had corneal gluing or perforation.
Regarding the P-T framework, accessibility encompassed the distance to the appointment and transportation, availability included the scheduling of appointments and long clinic wait times, accommodation factors were the difficulty time away from work and dependent care responsibilities and affordability included medication and appointment costs. Acceptability was assessed by the dissatisfaction with the hospital or clinic and awareness focused on health literacy. Investigators also focused on other factors, such as medical comorbidities and other family issues.
A total of 101 patients were recruited into the analysis. The mean age of patients was 51.7 years, 54% were women and most (88%) were White. Additionally, 92% were medically insured, 36% reported completing some college and 28% had an annual income between $51,000 and $100,000.
Most (60.4%) had one or more social risk factors, 4.0% had five or more risk factors and 39.6% reported no risk factors that impacted care.
No significant differences in demographics were observed in the categorical measure determination. However, significant differences in the number of risk factors were shown between income levels, with those with lower incomes reporting more risk factors.
Most subjects reported accessibility issues that impacted ongoing care, with 75.4% reporting the distance to appointment as a risk factor. Medication cost (23%) and transportation (21.3%) were among other risk factors, in addition to difficulty taking time away from work or home (19.7%). Eight patients said they had awareness concerns and six reported acceptability factors.
Among the 16% of the cohort that were lost to follow-up, all had at least one social risk factor including medical comorbidities. These patients were more likely to have social risk factors and experienced a greater number of these factors when compared with patients who were not lost to follow-up.
Investigators said the social risk factors analyzed in the study were most likely underestimated due to assessing this data using retrospective reviews of their charts. Another limitation was that data was collected from a singular tertiary eye center, so other risk factors may be more prevalent at other sites.
“A system to prospectively capture and assess social risk factors could be implemented by using standardized intake forms and be tailored to the social risk factors described in the study,” investigators concluded.
Social Determinants Impact Microbial Keratitis Treatment Access
Low-income patients with microbial keratitis face more significant challenges in accessing care, including transportation and medication costs, according to new research.
By Lana Pine | Published on October 21, 2024
5 min read
Credit: Adobe Stock/Pixel-Shot
A study presented at the 128th Annual American Academy of Ophthalmology (AAO) Meeting showed that multiple social risk factors of healthcare access impacted healthcare access among patients with microbial keratitis (MK), particularly for those with lower income.
“Understanding social risk factors is the first step to improving access to care for patients with MK,” said a team of investigators led by Madeleine C. Lee, BS, associated with the Department of Ophthalmology and Visual Sciences at the University of Michigan.
MK currently affects approximately 1.5 to 2 million patients worldwide, with social risk factors affecting a patient’s ability to access care. The Penchansky and Thomas (P-T) framework identifies these factors that affect the ability for patients to receive MK care. They include affordability, availability, accessibility, awareness, accommodation or adequacy and acceptability.
Investigators sought to identify the social risk factors using this framework. Eligible patients were recruited from a prospective cohort at the University of Michigan between August 2020 and December 2023 and had a new diagnosis of clinically significant MK. These patients were followed up for up to 90 days. Data were collected using prospective interviews in conjunction with a retrospective chart review. These factors were assessed as both categorical—meaning no social risk factors or one or more factors—and continuous measured, defined as the number of risk factors.
Patients excluded from the study were younger than 15 years of age, had previous incisional corneal surgery, were currently pregnant or incarcerated and/or had corneal gluing or perforation.
Regarding the P-T framework, accessibility encompassed the distance to the appointment and transportation, availability included the scheduling of appointments and long clinic wait times, accommodation factors were the difficulty time away from work and dependent care responsibilities and affordability included medication and appointment costs. Acceptability was assessed by the dissatisfaction with the hospital or clinic and awareness focused on health literacy. Investigators also focused on other factors, such as medical comorbidities and other family issues.
A total of 101 patients were recruited into the analysis. The mean age of patients was 51.7 years, 54% were women and most (88%) were White. Additionally, 92% were medically insured, 36% reported completing some college and 28% had an annual income between $51,000 and $100,000.
Most (60.4%) had one or more social risk factors, 4.0% had five or more risk factors and 39.6% reported no risk factors that impacted care.
No significant differences in demographics were observed in the categorical measure determination. However, significant differences in the number of risk factors were shown between income levels, with those with lower incomes reporting more risk factors.
Most subjects reported accessibility issues that impacted ongoing care, with 75.4% reporting the distance to appointment as a risk factor. Medication cost (23%) and transportation (21.3%) were among other risk factors, in addition to difficulty taking time away from work or home (19.7%). Eight patients said they had awareness concerns and six reported acceptability factors.
Among the 16% of the cohort that were lost to follow-up, all had at least one social risk factor including medical comorbidities. These patients were more likely to have social risk factors and experienced a greater number of these factors when compared with patients who were not lost to follow-up.
Investigators said the social risk factors analyzed in the study were most likely underestimated due to assessing this data using retrospective reviews of their charts. Another limitation was that data was collected from a singular tertiary eye center, so other risk factors may be more prevalent at other sites.
“A system to prospectively capture and assess social risk factors could be implemented by using standardized intake forms and be tailored to the social risk factors described in the study,” investigators concluded.
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