Background/Purpose: Uveitis is a major complication in patients with juvenile idiopathic arthritis (JIA) can be completely asymptomatic until vision loss develops. In order to prevent ocular complications, it is important to adhere to the recommended screening guidelines which range from every 3 to 12 months depending on JIA subtype, age of onset, duration of diagnosis and ANA status. However, this schedule may be difficulty for patients to adhere to. Little literature exists regarding compliance with uveitis screening in patients with JIA and we do not fully understand the barriers to obtaining screening eye exams. The specific aim of this quality improvement study as to assess barriers to obtaining screening eye exams in patients with JIA.

Methods: Patients with JIA were identified by ICD-9 code in our electronic medical record (EMR) prior to scheduled follow up appointments. They were then identified a adherent or non-adherent with established uveitis screening guidelines based on documentation of eye exams in the EMR. The guardians of those patients that were non-adherent were called the week prior to their scheduled appointments and a semi-structured interview was conducted. The interview included questions regarding the patient’s most recent eye exam, knowledge about the screening frequency, and barriers to completing the eye exams. The results were then analyzed qualitatively to determine any categorical variables present and the relative importance of each variable.

Results: 92 patients, ages 3-22 years, were identified as non-adherent to screening exam guidelines out of a possible 246 total patients with JIA with upcoming appointments. 45 guardians of these patients or patients older than 18 years were interviewed by phone. Responses were categorized into system problems, access to care,and knowledge. System problems (57.8%) represented the largest category. These problems included the most recent eye exam not being in the EMR, the wrong provider was identified in the EMR, or difficulty with scheduling an appointment. 48.9% of patients who were identified by review of EMR record as non-adherent with screening exams had parent/guardian reports of more recent eye exams. Lack of appropriate parent knowledge regarding uveitis screening was also identified as a key barrier with 26.7% unaware of how often screening exams should be performed. Access to care was the least cited category with 20% of those interviewed identifying a barrier such as transportation or insurance.

Conclusion: This qualitative study identified system problems as the greatest barrier to obtaining screening eye exams in this patient population. The most common system problem was the most recent eye exam not being in the EMR. Lack of knowledge also appears to contribute. These results will be helpful in planning the next steps in improving compliance with uveitis screening.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-barriers-to-uveitis-screening-in-patients-with-jia-a-qualitative-study/