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Ann P. Murchison, Lisa A. Hark, Julia A. Haller, Joseph A. Malunda, Benjamin Leiby, Yang Dai, Laura Pizzi; Access To Eye Care By Patients With Diabetes: A Retrospective Analysis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5744.
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To conduct a 4-year retrospective analysis to evaluate factors that impact access to eye care for patients with diabetes.
Electronic billing data was integrated with chart review data for patients with diabetes aged 40 years and older who were seen in the Wills Eye clinics between 1/1/2007-12/31/2010. Electronic data included evaluation date, diagnosis code(s), severity of diabetic retinopathy, demographic information, health insurance type(s), and referring physician. Chart review data included race/ethnicity, ocular co-morbidities, medications, duration of diabetes, presence of HgbA1C, date of dilated fundus exam (DFE), result of DFE, and ophthalmologist recommended follow-up. Multivariate analysis was used to examine predictors of DFE follow-up adherence
The mean age was 59 years (range 40-92 years) with 56% of the patients being female. The majority of the patients (86%) were from Pennsylvania, followed by New Jersey and Delaware (13%), and other states (1%). Most of the patients were African American (56%), unknown/unreported made up 24%, Caucasian 12%, Hispanic/Latino 5%, and Asian 3%. Annual follow-up was recommended for 74% of patients, within 6 months for 5%, and within 3 months for 21%. Most of the patients have only mild diabetic retinopathy. Adherence to follow-up was 48% for patients recommended to have 1-year follow-up and increased to 70% for those recommended to have 3-4 month follow-up. Gender and race/ethnicity had no significant impact in follow-up adherence rate. Severity of diabetic retinopathy and age were independent factors significantly associated with follow-up adherence (p <0.0001 and 0.0067 respectively).
Adherence to follow-up and timeliness of follow-up were worse for those with mild diabetic retinopathy and for those patients less than 65 years of age. These findings could help target methods to improve follow-up adherence in high-risk groups.
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