Barriers to Follow-Up After Teleretinal Screening for Diabetic Retinopathy at a Primary Care Site in an Academic Setting

Abstract

Purpose : Teleretinal screening for diabetic retinopathy has been proven to increase compliance with annual screening. However, appropriate follow-up is needed in patients with abnormal screens in order to ensure treatment of vision-threatening diabetic eye disease and preservation of vision. Few studies have identified patient-specific barriers to follow-up after abnormal screening. This study aims to identify barriers to follow-up beginning at the time of the abnormal screen result through completion of the follow-up visit.

Methods : 184 patients underwent teleretinal screening for diabetic retinopathy during a nine-month period between 2019 and 2020 at a single primary care site at The Ohio State University Wexner Medical Center. These charts were retrospectively reviewed to determine whether a referral to ophthalmology was placed by the ordering physician, an ophthalmology visit was scheduled after referral to ophthalmology was placed, and if the visit was completed for those with ophthalmology visits scheduled.

Results : Of the 184 patients who underwent screening, 80 patients had abnormal screens with recommendations to refer to ophthalmology. Abnormal screens included diabetic retinopathy, as well as other pathology requiring follow-up including retinal tear, choroidal nevus, glaucoma suspect, etc. Of these 80 patients, 60 were referred to ophthalmology. 45 of 60 (75%) patients scheduled appointments. Factors identified as barriers in scheduling appointments include inability to successfully contact patient and patient declining to schedule when contacted. Of the 45 who scheduled appointments, 23 appointments were completed. 17 patients cancelled and 5 patients failed to show for their scheduled appointments.

Conclusions : Overall completion rate of follow-up visit after abnormal teleretinal screen in this study was 29%. While patient factors including lack of clarity in process following screening and cost have been previously identified as barriers to follow-up after teleretinal screening, other factors that impact follow-up include placement of referrals by the ordering physicians, ability to contact patients to schedule appointments, and patients declining to schedule appointments. Further research is necessary to elucidate barriers in placement of referrals, as well as ability to contact patients and successfully schedule appointments after abnormal teleretinal screen.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.