Non-adherence to eye care in people with diabetes

Abstract

ObjectiveEvaluate individual factors that impact adherence to eye care follow-up in patients with diabetes.Design and methodsA 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit.ResultsOverall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index.ConclusionsPatients with moderate to severe DR and/or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.

Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes

“…Various studies conducted in Western populations revealed factors associated with nonadherence that were similar to that elicited in our traditional multivariable analyses, specifically with regard to higher triglyceride levels and less severe DR. 8 , 12 , 17 Considering that DR has few visual symptoms until the disease becomes quite advanced, 18 it is not unusual for patients with mild disease to not realize the importance of early intervention, which likely explains our observation of the association between milder disease with higher rates of nonadherence rates to PSOR. In contrast, despite an established correlation between poor disease control and lack of adherence to various disease intervention strategies, 19 it is surprising that only higher triglyceride levels, and not other indicators of poor control, for example, raised HbA1c and blood pressure levels, were significantly associated with increased risk of nonadherence to PSOR in our study.…”

“…However, it is important to note that our study was retrospective in nature, and as such we may not have collected all potential factors associated with nonadherence to PSOR, such as a patient's clarity with regard to the referral process; patients’ perceptions on DR and their view on the importance of eye examinations; distance, travel time, and mode of transportation to the tertiary hospital; as well as whether these individuals were privately insured, all of which have been established to play a role in the uptake of tertiary eye referrals. 17 , 20 , 21 Furthermore, our participants were drawn from government polyclinic databases and may not reflect individuals who chose to follow-up with doctors from private practice. Finally, a limitation of our approach was that we utilized the same data to build and evaluate the model, which may have led to an overestimation of model performance.…”

Development of a Clinical Risk Assessment Tool for 6-Week Postpartum Visit Nonadherence

“…A 4-year retrospective study of patients diagnosed with diabetes demonstrated similar risk factors to nonadherence: race, insurance status, and driving distance to appointment location. 11 A study of orthopaedic trauma patients observed similar outcomes, showing that postoperative follow-up loss was significantly associated with driving distance to clinical site, and insurance status, among other risk factors. 12 Hospitals and clinics have in response attempted to take steps to address 6WPP nonadherence.…”

A renaissance of teleophthalmology through artificial intelligence

“…The rate of prematurity in the United States has increased to 13% but only 54% of eligible retina or pediatric specialists are willing to manage retinopathy of prematurity (ROP) [7]. Regarding screening for diabetic retinopathy (DR), 58% of patients with diabetes fail to obtain follow-up dilated fundus exams [8]. Understandably, in its current state teleophthalmology has found the most use in DR and ROP screening to address these significant shortages of care.…”