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Rachel Shah, Ana Paula Morales Allende, Nicole Bernstein, David Rubaltelli, Umar Mian; Evaluation of follow-up rates among non-compliant patients participating in a telemedicine program for diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2898.
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© ARVO (1962-2015); The Authors (2016-present)
The National Eye Institute recommends the early detection and treatment of diabetic retinopathy (DR), yet patients suffering from early stages of the disease tend to be asymptomatic. Given the high prevalence, increased morbidity, and increased mortality from diabetes in the Bronx, a protocol was created to diagnose DR remotely, using a fundus-photo based teleophthalmology program. The purpose of this study is to evaluate follow-up rates of patients positively diagnosed with DR by the program and to identify systemic barriers in achieving appropriate follow-up amongst our patient population.
Non-compliant diabetic patients who screened positive for diabetic retinopathy were scheduled for follow-up exams at Montefiore. Those who missed their appointments were contacted via telephone and surveyed using a standardized script. Oral consent was obtained prior to administering the survey. All information was obtained directly from the participants or a health care proxy. Participants were not offered any compensation for completing the survey.
Between January 2015 and August 2016, 1468 participants underwent screening for diabetic retinopathy. 275 participants received a grading of R > 0, representing evidence of some form of DR on screening photos. 158 participants had follow-up appointments scheduled in our practice during the analysis period. 49 of the 158, or 31%, did not present for their follow-up visit. 18 patients who missed their appointments were reachable by phone, and 17 completed our survey. The remaining 31 patients either provided an invalid number (14) or were left messages and did not return our calls (17).
Although our sample size was limited, we can infer that patients did not prioritize follow-up with an ophthalmologist due to lack of health education and limited understanding of the urgency to treat diabetic retinopathy as a sight-threatening condition. The fact that over 60% of patients who did not present for follow-up either provided an invalid contact number or did not return health-related messages suggest that high rates of incorrect patient contact information may underly patient compliance. We hope that further investigation into follow-up rates from our program will reinforce these preliminary findings and provide us with the information necessary to increase patient compliance.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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