Abstract
Purpose :
Patients with non-proliferative diabetic retinopathy (NPDR) may experience visual changes and prompt patients to seek emergency department (ED) evaluations. Ideally, with a new or prior diagnosis of NPDR, patients should be followed closely to prevent progression to proliferative diabetic retinopathy (PDR) and irreversible visual impairment. The purpose of this study was to determine the rate of follow-up after ED encounters in patients diagnosed with NPDR and to identify factors associated with follow-up non-compliance.
Methods :
A retrospective cohort study of patients with active NPDR presenting to an ophthalmic ED between May 2014 and December 2018 was conducted. Demographic and encounter data were collected (Figure 1). Compliance with follow-up was defined as a completed clinic visit as scheduled or within 4 weeks of the recommended follow-up after the ED encounter. Logistic regression was used to estimate the odds ratios for an association between explanatory and outcome variables.
Results :
A total of 390 emergency department encounters were reviewed. Patients without NPDR, with PDR, or follow-up with outside providers were excluded. In the end, 248 patients were included. The overall compliance with follow-up rate was 45.2%. A home zip code further from the ED had a decreased odds of non-compliant follow-up; however, it did not reach significance (odds ratio [OR]: 0.98, p=0.079). Patients with a longer recommended follow-up and longer interval to scheduled follow-up had significantly increased odds of non-compliant follow-up (OR: 1.13, p=0.002; OR: 1.01, p=0.028) (Figure 2). The other characteristics were not significantly associated with follow-up non-compliance.
Conclusions :
Patients who presented to an ophthalmic ED with NPDR are at risk to be non-compliant with follow-up. Characteristics that increased the odds of follow-up non-compliance included a longer recommended interval to follow-up and longer scheduled interval to follow-up. Based on this information, clinicians should consider scheduling the first follow-up appointment shortly after the initial ED encounter.
This is a 2020 ARVO Annual Meeting abstract.