Factors that affect adherence to diabetic retinopathy screening guidelines in an underserved ED population

Abstract

Purpose : Early screening and treatment for diabetic retinopathy (DR) have been shown to be cost-effective and lead to significantly better visual outcomes. The American Diabetes Association recommends an eye exam for DR every 1-2 years for those with diabetes, but studies have shown that adherence to this guideline has been poor.

The burden of improving patient adherence to screening for DR has often been placed on primary care physicians (PCPs). However, the emergency department (ED) is also becoming an entryway into the health care system for many patients, especially underserved populations. The ED is thus a critical and likely missed opportunity to educate, refer, and possibly screen for DR. The purpose of this study to evaluate disparities and barriers to DR screening for an underserved ED diabetic patient population.

Methods : 188 patients were surveyed in the Mount Carmel West ED from 6/8/2016 to 1/5/2017. Those who agreed to participate also consented to give permission to obtain relevant diabetes history from their electronic health record. This study was approved by the Mount Carmel Institutional Review Board.

Results : Out of the 188 patients, only 95 (51%) patients reported that they had a dilated eye exam for DR within the last year. Out of the remaining 93, 41 (44%) had an eye exam within the last three years, 34 (37%) had an exam more than three years ago, and 19 (20%) stated they have never had an eye exam. Out of the 93 patients who did not have an eye exam in the last year, 43 (46%) gave a financial reason as a barrier.

Factors associated with not having an eye exam in the last year were an Hba1c ≥ 7 (p = 0.050), presence of neuropathy (p = 0.029), and younger age (p=0.002). We did not find a statistically significant difference between gender, race, private vs public insurance, or having a primary care physician.

Conclusions : The ED may be a valuable opportunity to educate, refer, and possibly screen for diabetic retinopathy. A significant proportion of the ED diabetic population have not had a dilated eye exam in the last year and a significant proportion also had a financial barrier to doing so. Younger age and poorly controlled diabetes were associated a lack of adherence to eye exams.

This is a 2020 ARVO Annual Meeting abstract.

 

Table 1. Number of patients who selected each reason for not having an eye exam for DR in the last year. This included 93 patients total, and patients were allowed to select more than one reason.