Abstract
Purpose :
Although early detection of diabetic retinopathy (DR) is vital to prevention of vision loss, many patients fail to adhere to recommended DR screening and follow-up. A better understanding of why patients fail to comply with recommended eye exams is important for improving outcomes.
Methods :
An exploratory qualitative study was performed to identify factors affecting adherence by comparing patients who do and do not present for recommended DR eye exams. Patients were sourced from Kaiser Permanente Southern California’s (KPSC) Diabetes Case Identification Database to identify those with type II diabetes > 26 years old whose preferred language was English (n=34,347). Adherent patients were defined as those who attended a screening visit within a 12-month period, or a follow-up exam within 6 months of receiving notice of a positive screening result. Purposeful intensity sampling was used to categorize patients as either adherent or non-adherent with screening or follow-up visits. Patients were randomly sampled from each group and recruited by telephone for a semi-structured interview. Interviews were transcribed and coded in NVivo software. Thematic analysis of the transcripts was conducted, and recruitment continued until thematic saturation was achieved (n=29).
Results :
Sixty percent of the nonadherent patients knew they were nonadherent. Nonadherent patients reported that economic and practical barriers (such as inability to leave work during clinic hours) combined with a lack of self-discipline impeded adherence. Among adherent patients, self-discipline, strong social support, and the lack of practical barriers facilitated adherence. In contrast to other studies, we did not find knowledge of DR to be a primary factor affecting adherence. Fifty percent of adherent patients had very little knowledge of DR, and 50% of nonadherent patients had good knowledge of DR. Both adherent and non-adherent patients reported that adhering to recommended eye exams was a struggle in the context of their everyday life.
Conclusions :
Interventions aimed at improving patient knowledge of DR are necessary, but not sufficient to improve patient adherence with DR eye exams. Service delivery changes, such as weekend clinic hours or enhanced care coordination and outreach, may be needed in combination with patient education efforts to help patients overcome practical and psychosocial barriers.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.