Abstract
Purpose :
Diabetes mellitus and its primary ophthalmic complication, diabetic retinopathy (DR), continue to increase in prevalence worldwide. A large-scale teleretinal screening program has been utilized in the Harris County, the largest county in Texas, since 2013. While screening has improved DR screening compliance overall, a significant proportion of patients with sight-threatening diabetic eye disease (STDED) are lost to follow-up (FU). This study aims to identify barriers that may hinder patients from FU after a positive initial screening.
Methods :
Retrospective cohort analysis of patients in the Harris Health System (HHS) who were screened via nonmydriatic fundus photography at 13 primary care clinics in 2018. Of the 11,622 screened patients, 891 patients were detected to have STDED on teleretinal screening, and 333 patients failed to FU for an in-clinic evaluation by a retina specialist within 1 year of initial screening. Of this final cohort, 103 patients responded to a telephone survey questionnaire designed to explore their perceived barriers to FU.
Results :
The majority of survey respondents were English speakers (52.43%), and self-identified as Hispanic/Latino (61.17%). The most common reported barriers by nearly 47% of survey respondents were cost of the healthcare and lack of clarity in processes post-screening (Figure 1). Patients reported a mean commute time of 35.19 minutes (SD 25.52) to see a retina specialist and the average number of barriers reported by each patient was 2.46 (SD 1.58). No statistically significant relationship was found between language preference, screening location, commute time, or age/race/sex and the mean number of barriers reported.
Conclusions :
The HHS teleretinal screening program has significantly increased access to DR screening, but compliance following positive screening for STDED remains a challenge. Among patients found to have STDED on teleretinal screening in 2018, approximately 37.4% were lost to FU. Our study identified several factors that may preclude patients from FU, including cost, employment demands, transportation issues, and lack of understanding in post-screening instructions. Future quality improvement interventions, such as a refined process in providing patient instructions, are being planned based on these findings.
This is a 2021 ARVO Annual Meeting abstract.