Care Continuity and Risk of Glaucoma Surgery in Newly Diagnosed Primary Open Angle Glaucoma

Abstract

Pr & eacute;cis: Low care continuity increases the risk of glaucoma surgery in primary open angle glaucoma patients, especially in females and older adults. Enhancing care continuity may improve treatment outcomes. Purpose: To investigate the association between care continuity and the risk of glaucoma surgery in patients newly diagnosed with primary open angle glaucoma (POAG). Methods: This nationwide cohort study utilized data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) on patients who were newly diagnosed with POAG between 2004 and 2016 and had at least 4 ambulatory clinic visits for POAG within 2 years after diagnosis. On the basis of their continuity of care indices, we categorized participants into high and low-care continuity groups. We utilized the Kaplan-Meier method to determine the cumulative incidence of glaucoma surgery, excluding laser treatments, and applied Poisson regression to estimate incidence rates. We used a Cox proportional hazards regression model to assess the relationship between care continuity and the risk of glaucoma surgery in patients with POAG. Results: Among the 12,713 newly diagnosed patients with POAG, 6769 (53.1%) were female, with a mean (SD) age of 66.58 (8.24) years. The cumulative incidence of glaucoma surgery was significantly higher in patients with low care continuity (P<0.001). Similarly, the incidence rate of glaucoma surgery was higher in these patients (adjusted hazard ratio, 1.64; 95% CI, 1.31-2.06, P<0.001). This increased risk was particularly pronounced in female patients, patients aged >= 70 years, and those with lower comorbidities. Conclusions: Low care continuity is associated with increased risk of glaucoma surgery in patients with POAG. Therefore, interventions aimed at improving care continuity in patients with POAG should be considered to improve glaucoma treatment outcomes.