Educational and Personal Reminders to Improve Follow-Up to Vision Care in Patients with Diabetes: A Prospective, Randomized Trial

Abstract

 

Purpose

 

To evaluate the effectiveness of a personalized educational and telephone-based intervention on dilated fundus examinations (DFE) follow-up in patients with diabetes.

 

Methods

 

Prospective study of adults with diabetes who were recommended for a follow-up DFE. Over 7 months, 522 patients were randomly assigned to usual care or the intervention group. Usual care group (n=260) received a standard form letter reminding them to make an appointment and, once an appointment was made, they received an automated reminder phone call one day prior to their scheduled follow-up visit. Patients in the intervention group (n=262) received an educational brochure about diabetic eye disease and a personalized letter encouraging them to schedule an eye exam. Two weeks after the letter and brochure were mailed, a research assistant called to provide personal assistance to schedule a follow-up eye exam. Barriers to care utilization were also captured. Once an appointment was made, patients in the intervention group received a reminder letter 3 weeks prior to their appointment and an automated phone call one day prior to the scheduled follow-up visit.

 

Results

 

Patients in the intervention and control groups had similar demographics with regards to gender, race, and age. Overall, the majority of patients were female (66%) and African-American (70%). The mean age was 61 years (range 19-95 years). Patients in the intervention group were more likely to schedule an appointment (68% vs. 44%; relative risk 1.55; 95% confidence interval 1.29-1.79; p <0.0001) compared to the usual care group. Patients in the intervention group were equally likely to keep their appointment once scheduled compared to the usual care group (73.3% vs. 71.3%; p =0.71). Of those who did not make an appointment, common barriers reported included other medical conditions, lack of transportation, busy schedule, being a caretaker for a family member, and lack of health insurance.

 

Conclusions

 

Our study shows that the combination of a personalized educational and telephone-based intervention can significantly improve follow-up among patients with diabetes. A follow-up study has been initiated to determine the impact of each component separately as well the operational costs of each of these components.

 

Keywords: 499 diabetic retinopathy • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials