Abstract
Addressing health disparities in chronic disease prevention: A tele-medicine based diabetic retinopathy screening program
Haq Nawaz, MD, MPH and Christina Gentile, MPH
Griffin Hospital, Derby, CT
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
objectives: The goal of this project is to leverage innovative public health approaches from around the world and apply them to address health disparities in chronic disease prevention and health promotion in the Lower Naugatuck Valley by establishing a Collaborating Center for the Global Health and Territorial Health Research Network (GTHRN) at Yale-Griffin Prevention Research Center. The development of a screening program to detect retinopathy in diabetic patients is described, with an emphasis on how community and global partners worked together with regard to research, design, and implementation.
methods: The diabetic retinopathy screening will take place within the Lower Naugatuck Valley in our new clinic. We intend to conduct a small scale pilot project (N=100). We will utilize telemedicine to address the quality and access to diabetic retinopathy screening for residents of the aforementioned region. This screening program arose from observation of the Aravind Tele-Ophthalmology Network (ATN), who has demonstrated success in using mobile vans to conduct screenings in areas of rural Southern India.
results: Establishment of the GTRHN collaborating center, development of global health and community partners, and adaptation of a successful telemedicine prevention program are the project outcomes thus far. Additional data and program analysis will become available upon the start of the pilot project.
conclusions: The development of a diabetic retinopathy screening program is a useful model for communities seeking to increase the use of cost-conscious and efficient measures to increase retinopathy screening among diabetic patients, in the context of eliminating health disparities in chronic disease management.
Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Innovative Partnership to Improve Access to Eye Care Services for the Asian American Community
Susana Moreno, OD
University of Houston-HOPE Eye Clinic, Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Approximately 80% of global blindness is avoidable if available knowledge and interventions are implemented in a culturally and linguistically manner. According to the World Health Organization, Angle-closure glaucoma is a major cause of blindness in South –East Asian populations and can easily be detected during a comprehensive eye exam. Based on the Multi-Ethnic Pediatric Eye Disease Study Group, 70% of all decreased vision in Asian preschool children had an identifiable cause related to refractive error. Therefore early detection is key within this underserved population.
To better serve the multi-ethnic population of Greater Houston, the University of Houston College Of Optometry has created a unique partnership with the Asian American Health Coalition dba HOPE Clinic, a Federally Qualified Health Center, to increase access to eye care in a community based setting situated in the heart of Houston's Asia town. This partnership actively uses the same electronic medical record system (EMR) for all providers to co-manage the patients. Inter-department (between eye clinic, pediatrics, adult, internal medicine, nutrition, and behavioral health) communication and referrals are possible using the same EMR. To enhance patient understanding of the care they are receiving, health education and intake forms are available in multiple languages. Along with medical interpreters, this partnership is able to preserve vision within this high risk community. This partnership also yields learning opportunities for students in the health professional schools to understand co-management and also internal navigation process. Thus, future healthcare providers will be equipped to manage patients with an interdisciplinary approach.
Administer health education strategies, interventions and programs
Abstract
Socioeconomic Factors are associated with Early Cataracts in a South-Eastern Nigerian Community
Kevin Rolnick1, Sean Buck2, Kelechi Mezu-Nnabue, Dr. PH, O.D3, Jens Eickhoff, PhD2, Emma Esenwah, BSc, MSc, PhD, OD, FNCO4 and Olachi J. Mezu-Ndubuisi, MD, OD5
(1)University of Wisconsin, Madison, Madsion, (2)University of Wisconsin, Madison, Madison, (3)Mezu International Foundation, Pikesville, MD, (4)Federal University of Technology Owerri, Imo State, Nigeria, (5)University of Wisconsin School of Medicine and Public Health, Madison, WI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
BACKGROUND: Cataract is the leading cause of blindness in the world. A community health assessment done on over 1000 indigenes in a rural community in Imo State, Nigeria found a prevalence of cataracts in 64% of the working population above 41 years, causing a negative socio-economic impact. OBJECTIVE: This study investigated socio-economic and health risk factors in the community to better understand the milieu producing the high prevalence of cataracts. METHODS: A case-control study was implemented during a community medical outreach, with random selection of 61 patients above 40 years to undergo a medical exam to determine the presence or absence of cataracts and co-morbidities. A questionnaire was used to determine risk factors. RESULTS: Out of 54 complete records, 52% had cataracts while 48% had no cataracts. There was no difference in medical co-morbidities like ocular allergy (p=1.0), refractive error (p=0.1), hypertension (p=0.4), or arthritis/joint pain (p=0.8) between people with or without cataracts. The group without cataracts had more years of education (p=0.01) and a higher socio-economic score (SES) (p=0.01). Both groups had low frequency of preventive medical visits (p=0.2) and obtained medications from pharmacies without a prescription (p=1.0). There was no difference in duration of sun exposure (p=0.3), use of multivitamins (p=0.8), sunglasses (p=0.3), and hats (p=0.8). CONCLUSION: Lack of finances in both groups influenced poor health practices (infrequent medical visits, prescription abuse, and infrequent sun protection) despite health knowledge. Focused risk factor education and increased access to medical services may reduce the incidence of cataracts in this community.
Assessment of individual and community needs for health education Chronic disease management and prevention Epidemiology Public health or related education Public health or related research Social and behavioral sciences
Abstract
Comparative analysis of satisfaction with the use of ready-made spectacles and custom-made spectacles among school children in Nigeria: A Randomized Controlled Trial
Bernadine Ekpenyong, OD, MPH, PhD, FNCO1, Kovin Naidoo, OD, MPH, PhD, FAAO , FCoptom(Hon)2, Ekanem Ekanem, B.Sc, MPH, PhD3, Antor O. Ndep, DrPH1, David Nwandu, OD4, Augustus Ezenwankwo, OD5, Kelechukwu Ahaiwe, OD, PGDE6 and Onyebuchi Ndukwe, OD, PGDE6
(1)University of Calabar, Calabar, Nigeria, (2)Brien Holden Vision Institute, Sydney, Australia, (3)College of Medicine, University of Lagos, Lagos, Nigeria, (4)Iconville Foundation, Calabar, Nigeria, (5)Benita Eye Clinic, Calabar, Nigeria, (6)University of Calabar Teaching Hospital, Calabar, Nigeria
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Refractive error is an important cause of visual impairment in Cross River State (CRS), Nigeria. Optical services and spectacles are not readily available to school children for the treatment.
Objective: To compare satisfaction with the use of ready-made spectacles and custom-made spectacles in the treatment of refractive error for school eye health programme
Methods: One month double-blinded Randomised controlled trial was used to evaluate satisfaction, symptoms, vision and planned continued use of ready-made and custom-made spectacles in school children 6 -17 years with ≥ 1 diopter of uncorrected refractive error. The sample size for each arm was 63. This research was funded by African Vision Research Institute (AVRI). Full ethical approval was obtained from the ethics committee CRS Ministry of Health, Nigeria. Data was analysed using SPSS version 20 and EPI info.
Results: Out of the 2110 children refracted with non-cycloplegic method, 243 (11.5%) has significant refractive error and only 104(82.5% response rate) met the inclusion criteria for the intervention study. There was no difference (p >0.05) in satisfaction (96.2% vs 96.2%) and symptoms ( headache 5.8% vs7.7%; eye strain 3.8% vs 1.9% ) in the use of ready-made vs custom-made spectacles to the 1 month follow up .
Conclusions. Ready-made spectacles are recommended for eye health programmes in schools because it is a cost effective strategy for treatment of refractive errors. The ready-made spectacles should be available in different frame pupillary distance for various powers to reduce discomfort associated with frame induced prismatic effect.
Epidemiology Provision of health care to the public Public health or related public policy
Abstract
Community-Based Eye Care for Seniors in Memphis Tennessee: A Pilot Program
Aaron Kerr, OD, FAAO, Christine Weinreich, JD and Mike Dorkowski, OD, FAAO
Southern College of Optometry, Memphis, TN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Community-Based Optometric Care for Seniors Pilot Program was developed to bring complete primary eye care to seniors close to their home to support aging in place in Memphis, Tennessee. The ability for an individual to stay in their home and live independently as they age is significantly dependent on the individual's health and access to health care. Regular eye exams can detect sight-threatening conditions that can impact an individual's independence and quality of life, and the percentage of eye health problems increases after the age of sixty.
Seniors can face barriers to obtaining regular eye exams due to cost, lack of insurance, limited income, and transportation challenges. The goal of this program was to cut barriers to accessing eye care while gathering data to identify what the most common barriers are and to determine the need for and design of comprehensive programming to provide community-based eye care for seniors. Approximately 550 Memphis area residents were provided comprehensive eye exams and one pair of glasses at no cost at locations close to their homes. If an individual needed follow up care due to an eye health condition, they were scheduled at our local clinical facility and transportation, if needed, was provided. No out of pocket expenses were accrued by the individual for any follow up care for a period of one year. Final data confirmed that, due to a variety of reasons, the majority of seniors served lacked sufficient access to optometric care.
Advocacy for health and health education Chronic disease management and prevention Provision of health care to the public
Abstract
Community based eye health screening study in the elderly Mexican American population in North Texas
Jennifer Deakins, O.D.1, Jenny Terrell, O.D., F.A.A.O2, Abbott Clark, Phd, FARVO3, Leigh Johnson, Phd4 and Sid O'Bryant, PhD4
(1)University of Houston College of Optometry, Community Eye Clinic, Fort Worth, TX, (2)Rosenberg School of Optometry at the University of the Incarnate Word, Community Eye Clinic, Fort Worth, TX, (3)University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, (4)University of North Texas Health Science Center, Fort Worth, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Health and Aging Brain Study Among Latino Elders (HABLE) is a recently developed study at the University of North Texas Health Sciences Center examining factors that influence aging in Mexican American Elders age 50 or older. HABLE uses a community-based participatory research approach and recruitment methodology. Recruitment consisted of community recruiters, community presentations, flyers/brochures, door-to-door recruitment, snowball recruitment, as well as newspaper advertisements. Participants undergo a fasting blood draw, medical examination, detailed interview, eye health screening, and neuropsychological testing. Eye health screenings consisted of visual acuity, slit lamp exam, pupillary response, eye movement, gross visual field, color vision, and posterior segment photographic imaging. To date, 74 individuals (age 63.1+/- 7.9 years) have been screened. Diabetes was clinically-diagnosed in 37.8% and systemic hypertension in 47.3% of the cohort. 9.5% had signs of diabetic retinopathy, and 15% had signs of hypertensive retinopathy. At distance, 16.2% of these individuals were determined to have a habitual visual acuity of 20/40 or worse and at near, 58.1%. Three patients (4.1%) self-identified as having glaucoma and AMD, which was supported by the fundus examination. 44.6% had peripapillary atrophy, while 27% had potential glaucoma phenotypes (large CD ratio, CD asymmetry, nerve fiber layer defects, rim thinning). In this elderly population, 79.7% had cataracts or were pseudophakic. Blood and serum are stored in a biobank for additional analyses and identification of potential predictive biomarkers. Clinical diagnoses of depression, dementia, and Alzheimer's disease as well as biomarkers for these conditions will be correlated with the eye health data.
Clinical medicine applied in public health Diversity and culture Other professions or practice related to public health Provision of health care to the public
Abstract
Diabetic Retinopathy Telemedicine in Primary Care Settings
Stacey Whanger, MPH1, Adam Baus, PhD, MA, MPH2, Ron Gross, MD3, Geri Dino, PhD3 and Dana King, MD3
(1)West Virginia Clinical Translational Science Institute, Morgantown, WV, (2)West Virginia University School of Public Health, Office of Health Services Research, Morgantown, WV, (3)West Virginia University, Morgantown, WV
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Despite universal consensus supporting yearly eye exams in patients with diabetes, nearly half have not received a dilated eye exam in the past year or were diagnosed too late for successful treatment. As a result, diabetic retinopathy is the leading cause of blindness among working aged patients. The high prevalence of diabetes in West Virginia (15.9%) combined with limited access to diabetic eye care resources in rural settings highlights the need to address these challenges at the local level. The collaboration between the West Virginia University Eye Institute and the West Virginia Practice-Based Research Network engaged a group of partners to implement increased access to eye evaluations by using advanced telemedicine technology in three primary care health systems. Patients previously diagnosed with diabetes, totaling 9097 across all three sites, are eligible for this service yearly. Clinical staff use a retinal scanning camera to capture images. Using a secure cloud-based system, retinal fellows grade with the interpretation available to the health system noting results and referral information. Preliminary project data has impacted WV Medicaid policies to now cover this service and continues to inform other insurers. This project demonstrates that this technology in rural areas increases eye care access and sight-saving detection and treatment of diabetic retinopathy. Our collaborative partnership of primary care providers, clinical staff, ophthalmologists, industry specialists, information technology specialists, insurance providers, and public health agencies impacts clinical patient quality measures, better distributes ophthalmic resources, and creates transformative practice-level and policy-level change.
Chronic disease management and prevention Implementation of health education strategies, interventions and programs Other professions or practice related to public health Planning of health education strategies, interventions, and programs Public health or related organizational policy, standards, or other guidelines
Abstract
Assessment of Smoking Status among Urban Adults Presenting for Eye Examination who were Covered by Medicaid/Medicaid Managed Care Plans
Janis Ecklund Winters, OD
Illinois College of Optometry, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction:
Smoking has been associated as a causative/exacerbating factor in ocular/ systemic diseases. The 2012 National Health Interview Survey (NHIS) reported that 18.1% currently smoke. Medicaid expansion has allowed many to qualify for Medicaid/ Medicaid Managed Care Plans (MCP). Health disparities need to be assessed in this vulnerable population. The purpose is to assess smoking status as well as vision/health indicators among smokers.
Methods:
Medical records of new patients' ≥18 years who presented for eye exam were reviewed retrospectively. Those with Medicaid/MCP as a primary/ secondary insurance were included. Medical records were assessed for smoking status, age, gender, visual acuity (VA), and blood pressure (BP). Visually impaired (VI) was assessed if VA was >20/40 in the 'better seeing eye'. BP >140/90 mmHg was assessed 'elevated'.
Results:
Of the 3882 Medicaid/MCP adults that were examined/ had smoking status documented, 34.8% reported current smoking, 16.6% reported former smoker and 48.7% reported never smoked. A statistically significant higher prevalence of current smoking (40.3%) was reported by those 45-64 yrs compared to other age groups. Report of current smoking was significantly higher among males than females (43.8% vs. 29.5%). A statistically significant higher percentage of current smokers had BP elevated (38.4%) compare to former smokers/never smoked. Approximately 1% was assessed as VI regardless of smoking status.
Conclusions: More than one-third of Medicaid/MCO adults reported a current smoking. While VI levels were similar, elevated BP was more common among smokers. These finding underscore the importance of healthcare coverage and smoking cessation programs/education for this population.
Advocacy for health and health education Assessment of individual and community needs for health education Clinical medicine applied in public health Other professions or practice related to public health Provision of health care to the public
Abstract
Impact of daily cigarette smoking on the tear film
Daniel Powell, OD, PhD
Southern College of Optometry, Memphis, TN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: Smoking has been implicated as a dry eye risk factor despite the paucity of scientific evidence. Tear film lipids are believed to be altered by the oxidative components found in tobacco smoke. Degradation of these tear lipids may ultimately destabilize the tear film because of its reduced quality. The study purpose is to evaluate whether cigarette smokers are more likely than nonsmokers to exhibit the signs of a destabilized tear film.
Methods: Healthy individuals 18-44 years of age participated. Smokers were required to have smoked on a daily basis for at least the past three years. Nonsmokers must have worked and lived in a smoke-free setting. Tear film data and images were captured following completion of a blink using an interferometer that was developed in our laboratory. A small tear sample was collected and its contents analyzed via immunoassay for lipid oxidation biomarkers.
Results: The study sample consisted of 29 participants (15 smokers, 14 nonsmokers). There was no significant difference in mean ages between the two groups. Tear film quality and stability in smokers was overall reduced compared to their nonsmoking counterparts. Concentrations of lipid oxidation biomarkers were significantly greater in smokers compared to nonsmokers.
Conclusion: Daily cigarette smokers may be more likely than those who never smoked to have an unstable tear film. Individuals with an unstable tear film are more likely to present with the clinical signs of dry eye disease. Future work will focus on identifying the specific tear lipids that are targeted for oxidation.
Public health or related research