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Fabiana Silva, Mehreen Adhi, Rishi P Singh; Evaluation and referral of diabetic eye disease within the endocrinology and primary care office setting. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6316.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic eye disease is a treatable condition, and both the prevalence and the rate of progression can be reduced with cooperation between a knowledgeable physician and a motivated and aware patient. This study identifies if the diabetic provider asked or examined ophthalmic issues during their office encounter and determines if a referral for ophthalmic evaluation was provided to the patient.
Patients between 18 to 80 years of age with diabetes (defined by ICD-9 code) that had an office encounter with an endocrinologist or a primary care physician at Cleveland Clinic between January 2014 and December 2014 were identified. Detailed demographic data regarding patients clinical and biochemical status were collected. To evaluate the ophthalmic assessments performed, electronic charts were reviewed by two independent investigators for the key search terms. The search words were then graded as either 0=not identified, 1=asked about by the clinician, or 2=examined by the clinician during the encounter.
Charts of 1250 patients were reviewed. Approximately, fifty three percent of patients were female and the average age at encounter was 65.4 years old (± 9.8 years). The average HgbA1c was 7.46% and the average systolic and diastolic blood pressures were 130.27mmHg and 74.45mmHg respectively. In the cohort, 42.32% of patients were using insulin. Eye complaints were assessed in 82.9% of the endocrinology encounters and 27.5% of patients seen in primary care encounters. None of the search terms were mentioned to 8.06% of patients seen by endocrinologists and in 50.95% of patients seen by primary care physicians. Additionally, past and/or future ophthalmology appointments were verified in 78.5% of the endocrinology encounters, but only in 31% of primary care visits.
The present study shows a significant number of patients not screened for the ophthalmic signs and symptoms of diabetic eye disease, especially within primary care setting. Quality improvement measures are warranted to develop a better screening process at the primary care level such that patients at risk of DR are identified early to avoid treatment delays and thus avoidable vision loss.
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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