Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes

Eppley, Sarah; Mansberger, Steven L.; Ramanathan, Saras; Lowry, Eugene A.

doi:10.1016/j.ophtha.2019.05.033

Cited by 54 publications

(49 citation statements)

References 19 publications

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“…An awareness of regular examinations does not PLOS ONE always lead to action. Only 10.2% of the study participants actually had yearly or more frequent eye examinations, which is much lower than that reported in United States (63%) [32], Switzerland (71%) [33] and Jordan (76%) [34]. No national DR screening program has been implemented in China.…”

Section: Plos Onementioning

confidence: 72%

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

et al. 2020

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To investigate the knowledge and practices regarding diabetic retinopathy (DR) among diabetic patients included in a community-based primary health system (CBPHS) in China. Methods Diabetic patients aged 18 years and above registered in the CBPHS in Yueqing city, Zhejiang province were recruited. Information obtained by questionnaire included: demographic and socioeconomic status, knowledge about DR, and ocular and medical history. The primary outcome was whether the participant knew that DM can affect the eyes, defined according to the question: "Do you know diabetes mellitus (DM) can affect eyes? (yes or no)". A knowledge score was calculated based on the responses to seven questions, with 1 point awarded for a correct response and 0 points for an incorrect or uncertain answer. Results A total of 1972 diabetic patients were included in the study with an average age of 65.2±10.8 years, 45.7% were male. One thousand two hundred and nineteen patients (61.8%) knew that DM can affect the eyes. Significant differences in age, education, income status, insurance covering eye care, fasting blood glucose, duration of DM, history of hypertension existed between subjects who knew and those who did not know that DM can affect the eyes (P<0.05 for all). The proportion of correct answers to the DR knowledge questions ranged from 33.3% to 61.8%, with an average score of 3.65±2.47. In the multiple regression analysis, the knowledge score was significantly associated with age, education, income, history of hypertension, duration of DM, being told that regular examinations should be performed and concern about vision loss (P <0.01 for all).

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Section: Plos Onementioning

confidence: 72%

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

et al. 2020

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“…Previous studies have demonstrated that older patients with poorer diabetes control, as reflected by higher HbA1c levels, were more likely to seek ophthalmology services for a yearly eye examination. 48 , 49 Older patients may be more likely to need in-person eye examinations because of other comorbid age-related eye conditions. 50 Our study found that younger patients had higher rates of participation in tele-ophthalmology.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Kuo¹,

Anjum²,

Nguyen³

et al. 2021

OPTH

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Purpose We conducted a cross-sectional study to assess the utilization of a tele-ophthalmology screening program in a low-risk, suburban population of patients with diabetes. Methods A total of 214 diabetic patients without previously documented diabetic retinopathy (DR) underwent point-of-care non-mydriatic fundus photography through their primary care providers at five Beth Israel Lahey Health locations. The characteristics of the patients who received remote screening were compared with those patients who were eligible for screening but did not take part in the program. Time-driven activity-based costing (TDABC) was implemented to examine the cost of screening by tele-ophthalmology compared with in-person examinations. Results Tele-ophthalmology screening was more likely to be provided for patients who were younger (OR 0.985; 95% CI 0.973–0.997, p =0.016), who were obese (OR 2.04; 95% CI: 1.47–2.84, p =0.008), who had an HbA1c above 8.0% (OR 1.60; 95% CI: 1.13–2.26, p =0.031), or who had an eye examination in the past year (OR 5.55; 95% CI: 3.89–7.92, p <0.001). Those patients newly diagnosed with DR because of the program were more likely to have diabetic nephropathy (OR 7.79; 95% CI: 1.73–35.05, p =0.007). TDABC identified a health system cost-savings of between $8 and $29 per patient screened by tele-ophthalmology compared with the cost of in-person eye examinations. Conclusion Tele-ophthalmology presents an opportunity to reduce the costs of screening patients without prior evidence of DR, especially those who have completed a comprehensive eye examination within the prior year.

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“…This is because the average age of onset for type 1 diabetes is earlier than for type 2 diabetes and younger adults are less likely to obtain diabetic eye screening. 28,30 We defined the adherence window for diabetic eye screening as within the preceding 12 months based on AAO guidelines. 24 However, it is becoming increasingly accepted to extend the diabetic eye screening interval from 12 to 24 months for patients with a history of mild or no retinopathy per ADA guidelines.…”

Section: Discussionmentioning

confidence: 99%

Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care

Liu

Carlson

Diaz

et al. 2021

Telemedicine and e-Health

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Background: Teleophthalmology is a validated method for diabetic eye screening that is underutilized in U.S. primary care clinics. Even when made available to patients, its long-term effectiveness for increasing screening rates is often limited. Introduction: We hypothesized that a stakeholder-based implementation program could increase teleophthalmology use and sustain improvements in diabetic eye screening. Materials and Methods: We used the NIATx Model to test a stakeholder-based teleophthalmology implementation program, I-SITE at one primary care clinic (Main) and compared teleophthalmology use and diabetic eye screening rates with those of other primary care clinics (Outreach) within a U.S. multipayer health system where teleophthalmology was underutilized. Results: Teleophthalmology use increased post-I-SITE implementation (odds ratio [OR] = 5.73 [p < 0.001]), and was greater at the Main than at the Outreach clinics (OR = 10.0 vs. 1.69, p < 0.001). Overall diabetic eye screening rates maintained an increase from 47.4% at baseline to 60.2% and 64.1% at 1 and 2 years post-I-SITE implementation, respectively (p < 0.001). Patients who were younger (OR = 0.98 per year of age, p = 0.02) and men (OR = 1.98, p = 0.002) were more likely to use teleophthalmology than in-person dilated eye examinations for diabetic eye screening. Discussion: Our stakeholder-based implementation program achieved a significant increase in overall teleophthalmology use and maintained increased post-teleophthalmology diabetic eye screening rates. Conclusion: Stakeholder-based implementation may increase the long-term reach and effectiveness of teleophthalmology to reduce vision loss from diabetes. Our approach may improve integration of telehealth interventions into primary care.

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Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes

Cited by 54 publications

References 19 publications

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

Utilization of Remote Diabetic Retinal Screening in a Suburban Healthcare System

Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care

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