Background/Purpose: Uveitis is a major complication in patients with juvenile idiopathic arthritis (JIA) and 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 since diagnosis and ANA status. A previous study within our institution found that barriers to uveitis screening in patients with JIA include difficulty with scheduling appointments and poor knowledge of the screening guidelines. The specific aim of this study was to assess the utility of a mailed reminder letter to patients.

Methods:  Patients at Nationwide Children’s Hospital with JIA who were behind on their screening eye exams were identified through the PR-COIN registry. A reminder letter with information about uveitis and the patient’s specific uveitis screening guidelines was mailed to the patient’s address listed in the EMR. The guardians of those patients or the patients if over 18 years of age receiving letters were called one to two months after the letter was sent and a semi-structured interview was completed. The interview included questions regarding the letter, previous information the family had received about uveitis and ways the family would like to receive reminder notifications in the future.

Results:  44 patients were identified as non-adherent with the screening guidelines. 24 guardians of these patients or patients older than 18 years old were interviewed. 6 of the interviewees (25%) were able to recall receiving the letter in the mail and 4 of these 6 stated that they had read the letter. Of the 4 participants who had read the letter, 2 had been seen by ophthalmology at the time of the phone interview. Despite the low number of patients who remembered receiving the letter, 10 of the 24 interviewed indicated that mail would be the best way to communicate with them. Only 2 of the guardians interviewed (8%) did not know their child’s recommended uveitis screening frequency. Families identified a variety of methods for future communication including mail, email, text message and messages through an online patient portal.

Conclusion:  This qualitative study identified that a small percentage of families recalled receiving a mailed reminder regarding uveitis screening. Some of the families that stated they preferred mail for communication could not recall receiving the reminder letter. Other families identified other preferred methods for communication. Knowledge was less of a barrier than in our previous study. These results will be helpful in developing future tools for sending information and reminders to patients and their families.