Abstract
Purpose :
To identify whether endocrinologists and primary care physicians (PCP) adequately screened for ophthalmic symptoms/signs of diabetic retinopathy (DR) within office visits and provided timely ophthalmology referrals in patients with diabetes (DM) after quality improvement (QI) measures were taken.
Methods :
The primary study assessed screening of DR at the primary care level in a tertiary care institution in the year of 2014 through evaluation of electronic charts. It showed that endocrinologists and PCPs assessed ophthalmic symptoms/signs in 95.5% and 71% of DM patients, respectively (p<0.0001). QI measures including a webinar, two live programs and a CME roundtable were performed to improve the screening process in the primary diabetes care settings. In order to verify if there was improvement after the QI interventions, an electronic chart review was performed for patients from 18-80 years old seen by endocrinologists and PCPs after June 1st, 2016. Demographic data and patients` biochemical status were collected. To evaluate the ophthalmic assessments, electronic charts were reviewed for the key search terms, which were graded as either 0=not identified, 1=asked about by the clinician, or 2=examined by the clinician during the encounter. To verify the referral of DM patients to ophthalmic evaluation, one encounter with an endocrinologist or PCP was chosen randomly for each patient and the number of days since the last ophthalmic examination for diabetes was calculated.
Results :
A total of 600 patient records were reviewed. The mean age at encounter was 60.2 ± 13.2 years old and 52.5% of patients (n=315) were female. Provider asked about ophthalmic symptoms/signs in 88.3% (n=265) and 61.3% (n=184) of endocrinology and PCP office encounters, respectively (p<0.0001). Past and/or future ophthalmology appointments were verified in 78.7% (n=236) and 43% (n=129) of patients during endocrinology and PCP visits, respectively (p<0.0001). The mean number of days since the last ophthalmic examination was 53.2 ± 40.8 days for endocrinologists and 55.2 ± 37.3 days for PCPs (p=0.77). Table 1
Conclusions :
Ophthalmic complications from diabetes are still not adequately screened, especially within the primary care setting. This QI project involving directed medical education to physicians resulted in improvements in the referral of DM patients to ophthalmic evaluation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.