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Allison Pernic, Mark M Kaehr, Eric D Doerr, Jacob J Koczman, Chi-Wah Rudy Yung, Anh-Danh T Phan; Analysis of compliance with recommended follow-up for diabetic retinopathy in a county hospital population.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2290.
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To assess the association between insufficient follow-up and clinical and social parameters among diabetic patients at a metropolitan county hospital.
IRB-approved, case series study of the Wishard-Eskenazi Telemedicine Diabetic Retinopathy Screening Program (WETDRS) conducted in the primary care setting from June 2009 through February 2013. Patients having diabetic retinopathy (DR) were referred for eye clinic examination based on the American Academy of Ophthalmology’s Preferred Practice Pattern Guidelines. Adherence to recommended eye clinic follow-up interval classified patients as either compliant or non-compliant, determined through medical records review. Multivariate logistic regression analysis was performed to obtain adjusted odds ratios for compliance.
Of 258 patients referred, 93 were compliant and 165 were non-compliant. After adjusting for the impact of potential confounding variables, patients having lesser retinopathy (mild or moderate non-proliferative DR), age, and insulin usage (0 or 1 type) were significantly associated with non-compliance (p = 0.004, 0.007, and 0.013, respectively). Health insurance plan, hemoglobin A1c, number of comorbidities, and non-compliance with other medical appointments were not significant.
Patients with poor follow-up adherence were significantly more likely to have less severe DR or lower insulin requirement, suggesting correspondence of newly-diagnosed diabetes with lack of education on its effect or training in its medical care. Targeted education campaign at the primary care level in this vulnerable population to prevent future vision loss would be beneficial.
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