Perceived challenges in accessing ophthalmology care
Among the many challenges associated with rural living identified by the study participants, the main burden for all patients was the need to travel extensive distances to attend specialised clinics (Table 1 – case studies), with half of the patients citing the lack of available public transport services as a major barrier. The main reasons patients are unable to drive themselves to their visits were due to impaired vision or a procedure such as injections or eye dilation. Therefore, they rely on family/friends for support and time-sensitive visits depend on caregiver availability. In addition, poor ophthalmology health outcomes are accentuated by socioeconomic factors. For instance, four patients reported their limited ability to work and the financial pressure their condition poses on them, while the physicians acknowledge that populations in rural areas tend to be financially disadvantaged, with many not having appropriate health insurance (particularly in the USA), compared with those living in urban areas [2,3,4].
Considerations from a provider perspective
Medical centres adapt to the patient’s needs by scheduling multiple appointments on the same day, potentially leading to extended working hours for healthcare professionals (HCPs). A USA-based ophthalmologist suggested HCPs occasionally choose treatments that require less frequent clinic visits (e.g., Panretinal Photocoagulation) to ease the challenges for patients, ultimately aiding treatment compliance. However, it was noted that considerations beyond the patient’s travel impacted their decision, including the cost and approval of treatment by insurers. Furthermore, concerns regarding local pharmacies not stocking specialist medication (e.g., eye drops) were raised, as this could delay treatment.
Desired solutions
Caregiver/community groups, county-based or insurance-supported efficient healthcare transportation could reduce the burden for patients and their caregivers. Furthermore, digital health solutions, including virtual consultations and the use of digital devices (e.g., home-based Optical Coherence Tomography), could help reduce the cost of travel while providing medical support [5]. Lastly, selecting treatments associated with low administration frequency could potentially improve treatment adherence, disease management and ultimately the patient’s quality of life.
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