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Vicky Hwang, Puiyee Law, John K Yue, Jay Stewart, Daniel Chao; Predictors for Appointment Follow-up in Patients with Diabetic Retinopathy at a County Hospital. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1588.
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© 2017 Association for Research in Vision and Ophthalmology.
Diabetic retinopathy (DR) is the leading cause of preventable blindness in working class adults. Regular visits with ophthalmologists are essential to prevent vision loss; however, factors affecting appointment compliance have not been well studied for DR. Therefore, we utilized a cross-sectional study to determine predictors for consistent follow-up among DR patients at a metropolitan county hospital.
A total of 167 patients being treated for DR at the San Francisco General Hospital Eye Clinic for ≥12 months were recruited from June through December 2015. Data were collected via oral questionnaire and medical records were used to classify subjects into consistent versus inconsistent follow-up groups using the cutoff criteria of 80% appointment adherence. Univariate demographic and clinical predictors for consistent follow-up were analyzed using multivariable regression, and odds ratios (OR) with 95% confidence intervals (CI) are reported. Significance was assessed at p<0.05.
Overall, patients were 57.9±10 years old, 65% male, with 9.9±4.6 years of education. By race, 42% of patients were Hispanic/Latino, 32% Asian/Pacific Islander, 16% Caucasian, and 10% Black/African-American. Of 167 patients, 86 (52%) had consistent (≥80%) follow-up. Univariate predictors for consistent follow-up include public transit to clinic (60% vs. non-public 41%, p=0.018), insurance type (Medicare 69%, private 50%, Medi-Cal 48%, San Francisco Health 32%, p=0.021), primary language (Chinese 77%, English 51%, Spanish 46%, other 46%, p=0.042), and DR at time of diabetes diagnosis (60% vs. 45%, p=0.047), and visual impairment (best corrected visual acuity < 20/40) (60% vs. 46%, p=0.079) demonstrated a statistical trend. On multivariable regression, public transit to clinic (OR 2.29, 95% CI [1.11-4.73], p=0.026) and DR at time of diabetes diagnosis (OR 2.17 [1.04-4.53], p=0.038) persisted as predictors, and visual impairment emerged as a significant predictor for consistent follow-up (OR 2.34 [1.07-5.12], p=0.033).
Patients with less severe manifestations of DR and who do not utilize public transit as their primary means of traveling to clinic appointments are at higher risk of missing scheduled appointments, with implications for accelerated progression of vision loss. Clinicians should consider these risk factors to encourage adherence and improve patient outcome.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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