Abstract
Purpose :
Interruptions in the treatment of diabetic retinopathy (DR) pose a risk of disease progression and vision loss. This study aimed to identify factors linked to loss to follow-up (LTFU) after anti-vascular endothelial growth factor (VEGF) therapy for DR and piloted an electronic patient portal telehealth outreach program to return these patients to care.
Methods :
Patients with active DR receiving intravitreal injections (IVIs) were categorized as LTFU if they hadn't returned >90 days post-recommended follow-up. The intervention included reminders sent via the patient portal, when available, or U.S. mail, which contained an invitation to schedule a retinal examination and a symptoms questionnaire. Patients with acute symptoms were urged to contact the office, with the option of same-day appointments. Logistic regression identified factors linked to LTFU. Outcome variables included the rate of scheduled and completed appointments 90 days post-intervention. Intervention labor costs were estimated based on communication time.
Results :
Among 359 DR patients undergoing IVI treatment, 20% (n=72) were LTFU, averaging a delay of 466 ± 269 days. Factors associated with LTFU included residing farther from the clinic (26.0 ± 31.6 mi. vs. 17.0 ± 16.0 mi., p=0.001), failing to maintain low-density lipoprotein (LDL) control (35% vs. 53%, p=0.007), Medicare coverage (37.5% vs. 55.1%, p=0.011), lack of insurance (4.2% vs. 0.35%, p=0.033), lack of patient portal access (54% vs. 71%, p=0.008), and receiving fewer total IVIs (8.0 ± 7.5 vs. 21.6 ± 20.0, p<0.001). Reminders were sent to 39 patients via the patient portal (54%) and 28 via mail (39%). Five patients with scheduled visits were excluded (6.9%). Of those receiving patient portal messages, 55% accessed them and 12.8% scheduled visits. For mailed letters, 14.3% scheduled visits (p=0.862). Appointment adherence rates were similar (10.3% vs. 14.3%, p=0.616). Patient portal messages took an average of 64 seconds to send, resulting in a labor cost of USD 0.35 per message. In comparison, each mailed letter took around five minutes to prepare at a cost of USD 1.65 and required three to five business days to arrive.
Conclusions :
Re-engaging patients with DR through a patient portal-based outreach program is as effective as traditional postal methods but can be implemented at a lower cost, given patients have access to an electronic patient portal.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.