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I. Reich, M. T. Vincent, E. Kleiman, D. R. Lazzaro; The Role of the Primary Care Physician and Patient Adherence in Routine Screening for Diabetic Retinopathy in Diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4427.
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It is well established that the rate of yearly screening for diabetic retinopathy (DR) is poor. The purpose of this study is to examine which patient populations are least likely to be referred and screened for DR.
The charts of 52 patients were reviewed for documented referrals for yearly dilated fundus exams (DFE) and patient compliance. Age, gender, insulin dependence, HbA1c level, duration since onset of diabetes and insurance status were recorded.
52% of patients had documented referrals and 27% had documented DFEs. This percentage was similar for patients either older or younger than 60 years old. Females were slightly more likely to be referred and screened. Insulin dependent patients were referred more often and were more likely to be lost to follow up; non insulin-dependent patients were more likely to be screened. Patients with an HbA1c level of <7% all returned for follow up, were less likely to be referred, and were only slightly more likely to be screened than those with an HbA1c >9%. Despite their apparent adherence, 65% had no documented DFE, perhaps indicating poor patient education rather than poor compliance. Compared to patients diagnosed with diabetes within the past 5 years, patients with diabetes for longer than 5 years were referred less often, none had a confirmed DFE, and were far less likely to follow-up. Patients with private insurance had lower follow up rates, were slightly more likely to be referred and significantly more likely to be screened relative to patients receiving government sponsored insurance.
While there are generally poor rates of compliance with yearly DR screening, patients with an HbA1c below 7% and those with government sponsored insurance are patient populations which may benefit most from increased education about yearly DFEs.
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