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Yamina Rajput, Maxine Fisher, Tao Gu, Joseph Singer, Amanda Marshall, Seonyoung Ryu, John Barron, Adam Turpcu, Catherine MacLean; Patient and provider perspectives: Why are patients with diabetes mellitus noncompliant with dilated eye exams?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1440.
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To estimate the proportion of commercially insured persons with diabetes mellitus (DM) who do/do not receive annual dilated eye exams and, using perspectives of the patient and the provider, identify barriers to dilated eye exams and interventions that may improve compliance.
Patients with DM were identified from the HealthCore Integrated Research Database (HIRD). Patients who received ≥1 dilated eye exam between 8/1/11 and 7/31/13 were defined as compliant, per Healthcare Effectiveness Data and Information Set criteria.<br /> DM patients identified from the HIRD who were complaint and noncompliant with obtaining retinal exams, primary care physicians and ophthalmologists, who met eligibility criteria with New York City and Los Angeles zip codes, were invited to participate in 90-min focus groups conducted by an experienced moderator. Proceedings were recorded. Barriers and interventions cited were grouped into common themes and rank ordered.
Of the 339,646 DM patients identified via the HIRD, 43% were compliant (mean age 59.2 y) and 57% were noncompliant (mean age 54.5 y). A total of 29 patients (25 Type 2 DM, 18 male) and 18 physicians (9 PCP, 9 ophthalmologists) participated in the focus groups. Barriers to dilated eye exams are summarized in Figures 1 and 2. Helpful interventions cited by patients included: diabetic eye disease education, programs/sessions with diabetes specialists (if free of charge, covered by insurance, and held at a convenient time), motivational information on reminder postcards, incentives (e.g. discounts on eye glasses), or a case manager to coordinate, track, and inform patients about necessary tests and appointments. Interventions cited by providers included: a national spokesperson/celebrity who has dealt with diabetic retinopathy, DVD/Web links providing video education of the exam and disease, events/health fairs on diabetic retinopathy (similar to women’s health programs), pamphlets with retinopathy pictures, web-based education with links that can be publicized in-office, or alerts on electronic records system for physicians to reinforce reminders.
Numerous perspectives were identified on patient noncompliance with dilated eye exams, indicating the complexity of this issue. Providers and payers may want to consider these issues as they develop programs to improve rates of eye exams and outcomes among DM patients.
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