Introduction
Microbial keratitis (MK) is an emergent infection of the cornea that may result in permanent vision loss if not promptly treated.1 Social risk factors (SRFs), defined as adverse social conditions linked to poor health outcomes, affect patients’ ability to receive ongoing MK care.2,3 The Penchansky and Thomas (P-T) framework identifies six domains that affect access to healthcare: availability, accessibility, accommodation, affordability, acceptability, and awareness.4,5 Using this framework, we conducted a scoping review that found limited reports on the SRFs affecting MK care.2 The purpose of this study is to identify SRFs that affect MK care using the P-T framework.
Methods
This prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t-tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed.
Results
A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least one SRF impacting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, p=0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared to those not LTFU, had more SRFs (100% vs 52.4%, p=0.0001) and reported a greater median number of SRFs (3.0 vs 1.0, p<0.0001).
Conclusions
SRFs affected most patients with MK. Participants with lower income had more SRFs. Preemptively addressing accessibility and affordability will be critical to improve care and may improve patients’ ability to attend clinic appointments.
References
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2. Hicks PM, Kang L, Armstrong ML, et al. A scoping review of patients’ barriers to eye care for glaucoma and keratitis. Surv Ophthalmol. 2023;68:567-577.
3. Alderwick H, Gottlieb LM. Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems. Milbank Q. 2019;97:407-419.
4. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19:127-140.
5. Saurman E. Improving access: modifying Penchansky and Thomas’s Theory of Access. J Health Serv Res Policy. 2016;21:36-39.