Alabama Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (AL-SIGHT): The Impact of Financial Incentives on Health Care Engagement Following Telemedicine-Based Vision Screening.

Purpose: Financial incentives have proven successful in addressing health behaviors associated with several chronic diseases and may represent a potential method to improve adherence to follow-up eye examinations from vision screening programs. The study was conducted to determine the effect of financial incentives on follow-up adherence in the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine.

Methods: This study enrolled eligible patients receiving care at three Federally Qualified Health Centers to undergo screening for refractive error and ocular diseases. Follow-up appointments for continued care were made for patients suspected to have uncorrected refractive error or ocular disease. A subset of patients (n = 187) received a financial incentive while a control group did not (n = 234). Follow-up attendance within 6 months was compared with Poisson's models between incentivized and non-incentivized groups for all referrals and across specific disease states.

Results: Among 187 patients with and 234 without incentive, there was a significantly higher rates of follow-up in the incentivized group (83.4% incentivized vs. 74.4% non-incentivized, p = .05) overall. There was a significantly higher rate of attendance for patients referred for diabetic retinopathy (p = .02) and refractive error (p = .02), but not glaucoma (p = .46), glaucoma suspect (p = .70), ocular hypertension (p = .22), and cataract (p = .29). After matching across groups, these differences were less pronounced and only remained significant for diabetic retinopathy (p = .04).

Conclusion: Patients receiving financial incentive had a higher follow-up rate within 6 months. These differences where primarily driven by patients referred for refractive error and diabetic retinopathy. However, once matched for baseline covariates, this improvement was not seen in the overall group. This suggests that incentives may not be an effective method to improve adherence to vision screening in this setting especially for glaucoma screening.