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Lydia Marahrens, Daniel Röck, Tjalf Ziemssen, Andreas Fritsche, Focke Ziemssen; Hurdles and Barriers of Eye screening and Interdisciplinary Exchange: lessons learned from the DiabCheck study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2907.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze potential hurdles limiting the exchange of diagnostic and disease-related information for patients with diabetes
The DiabCheck® trial was a non-interventional cross-sectional study with recruitment in secondary diabetes centers. All patients of the investigator initiated study were included after confirmed diagnose of diabetes and underwent a comprehensive eye examination. A questionnaire evaluated self-perception, demographic characteristics, diabetes duration and type of treatment. Knowledge of HbA1c, time since last eye examination, level of education and metabolic control were investigated as potential predictors of absence from eye examinations or missing diagnostic reports in the dialectologist’s electronic file.For categorical outcomes, χ2-test was used to test for significant differences between the therapy groups. For continuous outcomes, significant differences were evaluated with the one-way ANOVA (α=0.05).
Questionnaires were available for 822 patients with diabetes (female: 362, male: 445; type 1: 252, type 2: 509).In the self-assessment of the information status the majority reported to be ‘well informed’ (428, 53%); 29 (4%) and 60 (7%) declared to be ‘not at all’ respectively ‘poorly informed’.137 (17%) persons of diabetes admitted not to know the last HbA1c value. Mean remembered value was 7.2% (range: 5.1 to 13, 95%-CI: 7.2- 7.4%). The mean of the last documented values was 7.4% (range 5 to 16, 95%-CI: 7.3- 7.5%).The participants claimed the interval since the last eye exam to be 6.5 months. 137 patients (17%) did consider a regular eye exam not to be necessary. For 305 subjects (37%), no information of the last eye examination was available for the diabetologist.In the patient's perspective, the most important barriers were waiting time (11.6%), co-payment (3.5%), fear of unfavorable findings/loss of driver's license (2.1%), distance to physician (0.7%).
When planning screening intervals, it should not be forgotten that the majority of patients is usually undergoing eye exams later and less often than initially intended. As there is a gap in all subgroups (independent of age), multiple measures have to be taken in order to prevent underdiagnose and falling through the net. The significant lack of diagnostic reports made a timely delivery of care and a response of non-ophthalmologists to diabetic retinopathy more difficult.
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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