Understanding access barriers to care in diabetic eye disease for underserved patients in Alabama: An expert interview study

Abstract

Background Underserved populations often have difficulty accessing care for diabetic eye disease, including screening, referral, and treatment. Although access barriers for diabetes care management have been well documented, less is understood of the access barriers for diabetic eye care specifically, and particularly among rural and underrepresented populations. This study aims to identify access barriers and opportunities to connect underserved patients in Alabama with diabetic eye screening and specialty care. Methods We conducted 12 semistructured interviews with experts in ophthalmology, diabetes care management, and primary care in Alabama between November 2023 and January 2024. We used the Health Equity Implementation Framework to code interviews and identify key themes related to access barriers and other obstacles to care, as well as opportunities to improve access to diabetic eye screening and treatment. Results Multiple factors associated with access barriers have been identified including aspects of the health care system in both inner and outer contexts, patient factors, and patient-provider interactions. We identified a mix of social, economic, and environmental barriers and opportunities at the patient and clinical encounter levels that influence access to eye care for underserved patients with diabetes in Alabama. Several innovative approaches were identified to improve patient access to eye care services at the health system level and during clinical engagement, including mobile clinics, expanded appointment times, one-stop shops, and improved information distribution before, during, and after the clinical encounter. Conclusions Several innovative approaches have been suggested by the experts to improve access to care across several domains, including transportation and clinic mobility, teleophthalmology, and improved information dissemination to patients on diabetic eye disease. Further research is needed to establish an evidence base for additional innovations aimed at improving access to diabetic eye care and expanding their scope through quantitative research efforts, both in Alabama and nationwide. Contributions to the literature · Diabetes management is complex, and diabetic eye care may not be prioritized, particularly among underserved patients, and in health care settings with access barriers and other constraints. · Identifying access barriers and opportunities to improve diabetic eye care among rural and underserved patients can improve overall care. · Transportation and clinic mobility, teleopthalmology and improved information distribution to patients throughout their care can all help improve patient access for diabetic eye care.