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Neepa Shah, Levi Kanu, Nicole Fuerst, Marisa Lau, Diane Dao, Egen Atkinson, Brian L VanderBeek; Visit Adherence in Diabetic Macular Edema Patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3264.
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To quantify adherence rates to physician recommended patient follow-up guidelines in the management of diabetic macular edema (DME).
All patients diagnosed with incident diabetic macular edema, who were managed at the Scheie Eye Institute, University of Pennsylvania between 2009-2014 were included in the study for analysis. A chart review was performed for each patient over the subsequent 2 years from their initial visit date. Demographic and clinical data was collected including all physician recommended follow-up intervals. Follow up that was outside the time period of study was not included in comparison analysis. Additionally, if a patient were to miss what could be considered multiple visits (ie. receiving injections and has a year between visits) only a single missed visit was counted.
Among 218 DME patients in our study, a total of 1033 visits were recorded, of which 854 could be assessed for follow-up adherence. The percentage of patients who adhered to their recommeneded follow-up schedule was only 26.4% but increased to 61.1% if a 7 day leeway period was given (similar to clinical trials). African American patients were more likely to miss a visit than white patients (OR:2.11; 95% CI: 1.00-4.45; p=0.048). Otherwise, no significant associations for missed visits were seen with gender, age, HbA1C, type of diabetes, macular thickness on OCT, or type of injection therapy between patients over time. Physicians decreased their follow-up frequency over time (ie. 41 days in 2013 vs. 56 days in 2009/2010, p<0.001), but the average number of visits for DME care per patient remained constant through this time period, ranging between 3.9-5.3 visits per year (p=0.17).
About 2/3 of patients with DME follow physician-recommended guidelines with regards to follow-up care for their DME. Physicians have decreased the average follow-up intervals, likely due to the increased use of anti-VEGF therapy, but intervals are still not as frequent as evidence-based protocols for DME which recommend follow-up every 4 weeks for the first year of therapy. Additionally, DME patients do not adhere well to follow-up recommendations and make far fewer visits per year (~5) than what is recommended by their provider (9 visits/year) or by evidenced-based guidelines (13 visits/year), likely contributing to the reduced visual acuity improvements reported in typical clinical settings.
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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