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B.D. Puent, G. Mitchell, K.K. Nichols; Adherence to Diabetic Standard of Care Guidelines . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3098.
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Purpose: The purpose of this study was to access optometric adherence to ADA diabetic patient care guidelines for yearly dilated exams. This study was designed to evaluate both sides of the doctor-patient relationship. Methods: Onsite chart reviews were performed at optometric practices to gather data on diabetic patients. Every tenth file was selected for review and only diabetic patient data was collected. The primary outcome of the study was frequency of dilation for diabetic patients. Secondary outcomes included chief complaint, time between examinations, reasons for non-dilation, and characterization of optometrists providing diabetic patient care. Results: The total number of files reviewed was 8320 with 683 of these being diabetic patients. On average, 4.2% of patients in optometric practice are recognized to be diabetic. The percentage of diabetic patients dilated for all comprehensive examinations was 77.4%. Approximately 39% of the diabetic patients met the ADA recommendation. Of diabetic patients seen within the last year, 86% were dilated. The two most common chief complaints at comprehensive examinations were blur (49.7%) and the need for a routine diabetic examination (25.9%). The average time since the last comprehensive examination was 1.91 ± 2.40 years. Of those with at least two comprehensive examinations (53.0%), the average time between the last two comprehensive examinations was 1.95 ± 1.48 years. Reasons for non-dilation included referral to ophthalmologist for dilated examination (18.8%), patient refusal (7.1%), anterior chamber intraocular lens implant (1.4%), and narrow angle (1.4%). In 66.5% of the non-dilated examinations no reason was recorded to explain why the patient was not dilated. In logistic regression analysis, characteristics of doctors that were less likely to dilate were older doctor age (OR=0.94; 95% CI: 0.90, 0.98), higher examination cost (OR=0.95; 95% CI: 0.92, 0.98), younger patient age (OR=1.03; 95% CI: 1.002, 1.05), two or less doctors in the practice (OR=0.22; 95% CI: 0.10, 0.52), and if patients had proliferative (OR= 6.60; 95% CI: 1.14, 38.22) retinopathy. Conclusions: While the majority of identified diabetic patients are being dilated at comprehensive examinations by optometrists, diabetics are not being seen every year as recommended. Optometrists should continue to educate diabetic patients on the need for yearly examinations, while maintaining proper records when dilation is not performed. Interventions to increase adherence to diabetic standard of care guidelines may be targeted at certain groups of optometrists.
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