The Department of Ophthalmology at the University of Pittsburgh School of Medicine strives to increase access to ophthalmic care in Pittsburgh.
Access to Eye Care
Access to Eye Care refers to the timely use of personal health services, and a patient's ability to access care is influenced by both individual (income, education, disability, level of trust in the healthcare system) and environmental factors (location and the number of providers).
According to Dr. Andrew Williams, access to care is more than finding appointment slots and filling them. It involves completely understanding all the individual social factors and barriers individuals face in maintaining those appointments. To improve access, we need to assess barriers to care, which are closely tied to social health determinants.
Drs. Williams and Sahel published an article about addressing social determinants of vision health, which the Eye & Ear Foundation wrote about.
Understanding Barriers to Care in Our Community
To begin understanding the barriers to care that people in our community face, a survey was conducted with attendees at the 2020 Mission of Mercy event. Three-fourths of screening attendees reported at least one barrier. When asked what obstacles they had in visiting an eye doctor, common themes emerged:
- Medical Cost/Insurance
- Difficulty navigating the system for appointments
- Transportation
- Provider accessibility
The group published an article based on its findings called “Characteristics Associated with Barriers to Eye Care: A Cross-Sectional Survey at a Free Vision Screening Event.”
Addressing patients’ social determinants of health and barriers to care is a complex task. The team thinks about solutions through the lens of Awareness, Adjustment, Assistance, Alignment, and Advocacy.
Awareness
The first step in addressing patients’ needs is identifying what needs are most urgent and most prevalent. In the clinic, this involves administering social risk screening questionnaires. The UPMC Vision Institute has been piloting these screenings to gather data about barriers patients face.
Assistance
The primary way the Department of Ophthalmology assists patients facing barriers to care is through their Patient Navigator, Dana McGinnis-Thomas, MHA. She is the liaison between the patient, healthcare system, and community. McGinnis-Thomas employs creative thinking and problem-solving to address nearly any need that would otherwise prevent patients from receiving the eye care they need.
A recent study found that she received 130 referrals for 125 patients over a three-month period. Of that group, 98% were resolved with intervention, and 90% with resolution. It is a highly successful program with 4.87/5 patient satisfaction.
“Building trusting relationships with the patient and community partners is critical to successful patient navigation,” states McGinnis-Thomas.
Adjustment
Clinical care must be provided that accommodates social barriers, like adapting written education materials concerning health literacy and offering telemedicine appointments.
Alignment
To assist the greatest number of patients with the best possible care, the Department is focused on aligning its programs and goals with long-standing, established organizations in the community. Two examples of their community vision outreach programs are Eyes on Wheels and the Mission of Mercy, which can only exist in partnerships with community-based organizations. More information on these two interventions can be found below.
Advocacy
Policies must be promoted to address health and social needs. This means promoting investment in research on health disparities and community-engaged research and advocating for policies that advance access to eye care.
Healthy Vision Lab
Led by Dr. Williams, the Healthy Vision Lab is an interdisciplinary research group that seeks to improve vision health by understanding and addressing barriers to care. The Healthy Vision Lab combines epidemiology, big data analysis, and health services research to address important public health issues in ophthalmology, such as follow-up for chronic eye disease and social determinants of vision health.
Ongoing projects include utilizing a national database to measure the magnitude of follow-up loss in glaucoma care, understanding reasons for appointment “no show,” measuring the success of patient navigation in ophthalmology, and examining the impact of community-based initiatives for vision health.
Community Outreach Efforts
Clothing Closet: The UPMC Vision Institute has a small clothing closet for patients who need to change clothes.
eyeVan: Used in free community vision clinics in the Pittsburgh region, the mobile eyeVan is like a doctor's office on wheels. It is equipped with medical technology to provide eye exams, screenings, and treatments for people in underserved communities and is used as part of Eyes on Wheels.
Garden Collaboration with the Western Pennsylvania School for Blind Children: Students and staff at WPSBC help with the gardens and landscaping of the Bruce and Barbara Wiegand Roof Terrace and the Rehabilitation Gardens at the Vision Institute.
Community Outreach Services: A student-run, free, mobile health clinic dedicated to eliminating barriers to eye care for patients in the Western Pennsylvania area that was established in 2005 by Evan “Jake” Waxman, MD, PhD, and medical students at the University of Pittsburgh Medical School. GES offers free comprehensive eye exams to individuals with barriers to care while providing medical students with a rare, essential opportunity to experience hands-on patient care early on in their medical education.
Mission of Mercy Pittsburgh: A free two-day dental, eye, and hearing clinic for the underserved members of our community, from the working poor and people experiencing homelessness to veterans and families who are uninsured or don’t have access to affordable health care.
Hillman Scholars Program: The University of Pittsburgh's ophthalmology research labs have been added as a site to the Hillman Scholars Program, which hosts students each summer to gain experience working in STEM. Students from economically disadvantaged districts are encouraged to apply and are given a stipend for their time.