Evaluating Quality of care and post-operative outcomes for Inuit patients in Nunavik

Theme: Global and public health ophthalmology
What: Global and public health ophthalmology
Part of: CAPHGO: Global Eye Care - Challenges beyond VISION 2020 with 2030 in Sight / CAPHGO: Soins oculaires mondiaux Défis au-delà de VISION 2020 avec 2030 en ligne de mire
When: 6/2/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 B

Abstract

Purpose

Indigenous patients in Nunavik face numerous challenges in accessing healthcare services, including limited access to cataract surgery, which requires extended leaves from their communities. With the substantial need for more research and quality improvement measures for Indigenous populations, we aim to examine current practices in place for Nunavik.

Study design

Retrospective chart review

Methods

Records of all Inuit patients undergoing cataract surgery at the McGill University Health Centre, the primary service centre for Inuit health, were reviewed from 2018 until 2023. The number of patients and timing of pre- and post-op visits were recorded. Baseline parameters, such as pre-and post-op best corrected visual acuity (BCVA), intraocular pressure (IOP), ocular or systemic comorbidities, and intra-op or post-op complications were collected.

Results

150 patients (252 eyes) were included. 97% of patients had a post-op day 1 (POD1) visit, while 95% and 8% of patients had post-op week 1 (POW1) and post-op month 1 (POM1) visits, respectively. 27 patients had bilateral cataracts, while 198 patients had unilateral cataract surgery. The mean time for the first post-op visit was 1 ± 0.0 days, the second post-op visit was 7.12 ± 2.43 days and the third post-op 36 ± 14.44 days. Patient compliance with scheduled appointments was 100% for POD1, 97% for POW1 and 85% for those scheduled for POM1. Patients saw a mean improvement of BCVA from 0.35 ± 0.29 (LogMAR) at PO visit 1 to 0.14 ± 0.19 (LogMAR) to the latest post-op visit (n=168 eyes). No post-op complications were observed for any of the patients. No difference in safety or efficacy outcomes was observed between POD1 and POW1 visits. Furthermore, there was no difference in BCVA or complication rates between patients who underwent unilateral vs. bilateral cataract surgery. Patients travelled at least 1572.5 KM from their homes to stay in Montreal for surgery and PO visits.

Conclusions

Our data shows no significant difference in outcomes between POD1, POW1 and POM1 visits, with a nearly 100% compliance rate for Inuit patients. This may suggest that it may be useful to reduce the timing of POW1 visit, (e.g., to 3 days) and promote follow-up through telemedicine or local optometrists located in Nunavik to minimize the time patients spend away from home. Ultimately, shorter postoperative stays in urban centres may significantly improve patient well-being and potentially save costs that can be reinvested in addressing healthcare disparities for patients from Nunavik communities.

Presenter(s)

Presenting Author: Sidratul Rahman

Additional Author(s):

Jacquelin Coblentz, McGill University

Abed Baiad, abd.baiad@mail.mcgill.ca

Bryan Arthurs, MUHC

Christian El-Hadad, MUHC

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