Abstract
Purpose: :
Despite well–publicized results of NEI randomized trials (RCT's)over 25 years, patients with diabetes mellitus continue to suffer preventable vision loss. Part of the challenge may lie in the care patterns of eye specialists. As such, we sought to characterize the baseline knowledge and care patterns for patients with diabetes mellitus on the part of community–based ophthalmologists and optometrists (the first 71 of 98 currently enrolled) participating in a prospective, randomized clinical trial of interventions to enhance the use of evidence–based diabetes eye care.
Methods: :
Twelve key domains (based on RCT results) in the eye care of patients with diabetes were identified and ranked by a national expert advisory panel. Specific evaluation items for each domain were also graded for both importance to care and for the level of detail needed for clinical care in the earlier study (NEI EY 11287). Pilot testing resulted in the identification of a subset of psychometrically representative items of high importance which were then used for baseline assessment of participating providers in the current study. Respondents completed the written, mail baseline survey prior to receiving any interventions in the study. Surveys were then scored by domain from 0 to 100.
Results: :
Mean scores for the twelve domains ranged from 39 + 9 (patient communications) to 69 + 11 (recognition of diabetic eye disease findings, the most important domain rated by the panel) among participants. Scores for the other 4 most important domains were: 66 (+ 20) for benefits of treatment of diabetes eye disease; 63 (+ 16) for exam components and follow–up care; 60 (+ 18) for the natural history of untreated diabetes eye disease; and, 57 (+ 21) for indications and contraindications for treatment of eye disease. In multivariate analyses for the 5 most important domains, greater length of time since completion of training was significantly associated with lower scores on the exam components and follow–up care domain.
Conclusions: :
Because the items on this baseline survey were rated as being highly important and were assessed only to a level of detail for each area judged important to know by the expert panel, the performance on this baseline survey indicates that significant opportunites exist for greater implementation of meaningful evidence–based care for diabetes eye disease. The finding of lower scores with greater length of time since completion of training is consistent with other studies and indicates a need for innovative approaches to care in the future.
Keywords: diabetes • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials