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Ravindranath R, Bernstein IA, Fernandez KS, Ludwig CA, Wang SY. Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening. JAMA Ophthalmol 2023; 141:1161-1171. [PMID: 37971726 PMCID: PMC10654926 DOI: 10.1001/jamaophthalmol.2023.5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Importance Regular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates. Objective To evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization. Design, Setting, and Participants This retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022. Exposures The associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions. Main Outcome and Measures The primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression. Results Of the 11 551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96). Conclusions and Relevance This study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.
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Affiliation(s)
- Rohith Ravindranath
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Isaac A. Bernstein
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Karen S. Fernandez
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Cassie A. Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Sophia Y. Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
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Wasser LM, Cassidy J, Cecconi K, McGinnis-Thomas D, Ayalon A, Zaheer HA, Waxman EL, Sahel JA, Williams AM. Predictors of Clinic Attendance After Community-Based Vision Screening. Transl Vis Sci Technol 2023; 12:2. [PMID: 37910081 PMCID: PMC10627300 DOI: 10.1167/tvst.12.11.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.
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Affiliation(s)
- Lauren M. Wasser
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - Julie Cassidy
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine Cecconi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dana McGinnis-Thomas
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anfisa Ayalon
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Haniah A. Zaheer
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L. Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Scanzera AC, Sherrod RM, Potharazu AV, Nguyen D, Beversluis C, Karnik NS, Chan RVP, Kim SJ, Krishnan JA, Musick H. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol 2023; 12:11. [PMID: 37831446 PMCID: PMC10587857 DOI: 10.1167/tvst.12.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose To explore barriers and facilitators to completing scheduled outpatient appointments at an urban academic hospital-based ophthalmology department. Methods Potential participants were stratified by neighborhood Social Vulnerability Index (SVI) (range, 0-1.0, higher scores indicate greater vulnerability), and semistructured interviews were conducted with individuals 18 years and older with an SVI of greater than 0.61 (n = 17) and providers delivering care in the General Eye Clinic of the University of Illinois Chicago (n = 8). Qualitative analysis informed by human-centered design methods was conducted to classify barriers and facilitators into three domains of the Consolidated Framework for Implementation Research: outer setting, inner setting, and characteristics of individuals. Results There were four main themes-transportation, time burden, social support, and economic situation-all of which were within the outer setting of the Consolidated Framework for Implementation Research; transportation was most salient. Although providers perceived health literacy as a barrier affecting motivation, patients expressed a high motivation to attend visits and felt well-educated about their condition. Conclusions A lack of resources outside of the health system presents significant barriers for patients from neighborhoods with high SVI. Future efforts to improve adherence should focus on resource-related interventions in the outer setting. Improving access to eye care will require community-level interventions, particularly transportation. Translational Relevance Understanding the barriers and facilitators within the Consolidated Framework for Implementation Research provides useful guidance for future interventions, specifically to focus future efforts to improve adherence on resource-related interventions.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - R. McKinley Sherrod
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
- College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Diana Nguyen
- Institute of Design, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Niranjan S. Karnik
- Institute for Juvenile Research, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robison V. P. Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sage J. Kim
- Division of Health Policy, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jerry A. Krishnan
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
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Huang BB, Radha Saseendrakumar B, Delavar A, Baxter SL. Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort. Transl Vis Sci Technol 2023; 12:14. [PMID: 36928128 PMCID: PMC10029769 DOI: 10.1167/tvst.12.3.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose To ascertain specific barriers of care among patients with diabetic retinopathy (DR) from different racial/ethnic groups. Methods In this cross-sectional study, we included adult participants in the National Institutes of Health All of Us Research Program with DR who answered questions in the Healthcare Access & Utilization survey and Social Determinants of Health (SDoH) survey. Logistic regression was used to study the association between barriers to care and race/ethnicity. Results Our cohort included 885 DR patients who answered the Healthcare Access & Utilization survey and 385 DR patients who responded to the SDoH survey. After adjusting for confounders, Hispanic individuals were more likely than non-Hispanic White individuals to report delaying getting medical care due to not being able to get child care (odds ratio [OR] = 6.57 [95% confidence interval {CI}, 1.67-27.8]). Furthermore, compared to non-Hispanic White individuals, non-Hispanic Black individuals were significantly more likely to report being treated with less respect (OR = 2.62 [95% CI, 1.15-5.80]), treated with less courtesy (OR = 2.51 [95% CI, 1.01-5.92]), and receive poorer service than other people (OR = 2.85 [95% CI, 1.25-6.34]) when they go to a doctor's office or other healthcare provider. Conclusions We found that Hispanic and non-Hispanic Black individuals with DR reported greater delays/barriers to care compared to non-Hispanic White individuals even after controlling for individualized socioeconomic factors. Translational Relevance This study highlights the importance of taking steps to promote health equity, such as increasing access to child care resources and reducing implicit bias among eye care providers, to increase access to care and prevent vision loss from DR.
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Affiliation(s)
- Bonnie B. Huang
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Arash Delavar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
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Jotte A, Vander Kooi W, French DD. Factors Associated with Annual Vision Screening in Diabetic Adults: Analysis of the 2019 National Health Interview Survey. Clin Ophthalmol 2023; 17:613-621. [PMID: 36843957 PMCID: PMC9946010 DOI: 10.2147/opth.s402082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/09/2023] [Indexed: 02/20/2023] Open
Abstract
Purpose To determine the association(s) between receiving an annual eye exam and various economic, social, and geographic factors assessed in the 2019 National Health Interview Survey (NHIS) among adults with diabetes. Patients and Methods Data from adults 18 years of age and older relevant to self-reported non-gestational diabetes diagnosis and eye exam within the last 12 months were extracted from the 2019 NHIS dataset. A multivariate logistic regression model was used to determine associations between receiving an eye exam in the preceding 12 months and various economic, insurance-related, geographic, and social factors. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Among diabetic adults in the US, receiving an eye exam within the last 12 months was significantly associated with female sex (OR 1.29; 95% CI 1.05-1.58), residence in the Midwestern United States (OR 1.39; 95% CI 1.01-1.92), use of Veteran's Health Administration healthcare (OR 2.15; 95% CI 1.34-3.44), having a usual place to go for healthcare (OR 3.89; 95% CI 2.16-7.01), and the use of Private, Medicare Advantage, or other insurance (OR 3.66; 95% CI 2.42-5.53), use of Medicare only excluding Medicare Advantage (OR 3.18; 95% CI 1.95-5.30), dual eligibility for Medicare and Medicaid (OR 3.88; 95% CI 2.21-6.79), and use of Medicaid and other public health insurance (OR 3.04; 95% CI 1.89-4.88) compared to those without insurance. An educational attainment of less than high school (OR 0.66; 95% CI 0.48-0.92), and an educational attainment of high school or GED without any college (OR 0.62; 95% CI 0.47-0.81) reduced the odds of having an annual eye exam. Conclusion Economic, social, and geographic factors are associated with diabetic adults receiving an annual eye exam.
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Affiliation(s)
- Alec Jotte
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Dustin D French
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Departments of Ophthalmology and Medical Social Sciences, Northwestern University, Chicago, IL, USA,Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL, USA,Veterans Affairs Health Services Research and Development Service, Chicago, IL, USA,Correspondence: Dustin D French, 645 N. Michigan Ave., Suite 440, Chicago, IL, 60611, USA, Tel +1 312 503 5590, Fax +1 312 503 8152, Email
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Lai TC, McDaniel CC, Chou C. Diabetes management behaviors associated with depression in the U.S. Diabetol Metab Syndr 2022; 14:178. [PMID: 36419073 PMCID: PMC9685969 DOI: 10.1186/s13098-022-00953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a lack of nationally representative evidence from the U.S. investigating the relationships between depression and diabetes management behaviors. Our study aimed to assess the associations between diabetes management behaviors and depression status, and to compare U.S. population-level percentages of diabetes management behaviors among patients with and without depression. METHODS A cross-sectional study was conducted using population-based survey data to assess patient-reported variables retrospectively. We used the Behavioral Risk Factor Surveillance System (BRFSS) data and included states in the U.S. that continuously adopted the diabetes optional modules in 2013, 2015, 2017, and 2019. We included U.S. adults (≥ 18 years old) with self-reported diabetes in our analysis. Main outcomes were diabetes management behaviors (i.e., self-check for blood glucose and feet sores/irritation, regular diabetes clinical visit, HbA1c check, professional feet check, and dilated eye examination) and lifestyle behaviors (i.e., exercise, smoking, and alcohol consumption). RESULTS Among the 74,011 respondents with diabetes, patients with depression had a higher likelihood of performing routine HbA1c checks (adjusted odds ratio (AOR) = 1.12; 95% CI 1.01-1.23) but had a lower likelihood to perform regular self-check for blood glucose (AOR = 0.91; 95% CI 0.84-0.99), receive professional feet checks (AOR = 0.87; 95% CI 0.79-0.95), and receive a dilated eye examination (AOR = 0.89; 95% CI 0.82-0.98). For lifestyle behaviors, patients with depression were more likely to smoke (No smoking (AOR) = 0.65; 95% CI = 0.59-0.72) and less likely to engage in sufficient exercise time (AOR = 0.69; 95% CI 0.63-0.75). There were no significant associations between depression and other behaviors, including self-check for feet sores/irritation (AOR = 0.99; 95% CI 0.92-1.08), regular diabetes clinical visit (AOR = 1.03, 95% CI 0.94-1.13), and alcohol consumption (AOR = 1.01, 95% CI 0.92-1.10). CONCLUSIONS The association between depression status and diabetes management behaviors varied. People with depression were positively associated with HbA1c checks. However, less uptake of other behaviors may indicate the needs for improvement in diabetes management.
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Affiliation(s)
- Tim C Lai
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA
| | - Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL, 36849, USA.
- Department of Medical Research, China Medical University Hospital, Taichung City, Taiwan.
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Zhou Y, Li X, Sun Q, Wei J, Liu H, Wang K, Luo J. Adherence to Annual Fundus Exams among Chinese Population with Diagnosed Diabetes. J Clin Med 2022; 11:jcm11226859. [PMID: 36431336 PMCID: PMC9697630 DOI: 10.3390/jcm11226859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range of data every 2 years, including demographic, socioeconomic, medical and lifestyle-related information. The adherence rates to annual fundus exams across four waves (2011−2018) were assessed. Univariate and multivariable logistic regressions were used to determine factors associated with adherence. The adherence rates to annual fundus examinations of ou study population were 23.6% in 2011, 15.3% in 2013, 17.5% in 2015 and 21.5% in 2018, respectively. Consistent results over four waves showed that non-adherent patients had a relatively lower educational level, insufficient diabetes medication use, fewer non-medication treatments and irregular physical examination compared to those who were adherent to the annual fundus exam (all p values < 0.05). These variables were further identified as factors associated with adherence according to univariate and multivariate logistic regression analyses (all p values < 0.05). The present study provides explicit evidence that the adherence rate to annual fundus examinations among Chinese population with diabetes is worryingly low. Insufficient educational attainment, especially specific diabetes education, has a negative impact on patients’ adherence to clinical guideline for eye health.
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Affiliation(s)
- Yifan Zhou
- Department of Ophthalmology, Putuo People’s Hospital, Tongji University, Shanghai 200060, China
| | - Xiaowen Li
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Qinglei Sun
- Department of Ophthalmology, Shanghai East Hospital, Shanghai 200120, China
| | - Jin Wei
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai JiaoTong University, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai JiaoTong University, Shanghai 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai 200080, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
| | - Keyan Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Correspondence: (K.W.); (J.L.)
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
- Correspondence: (K.W.); (J.L.)
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Solomon SD, Shoge RY, Ervin AM, Contreras M, Harewood J, Aguwa UT, Olivier MMG. Improving Access to Eye Care: A Systematic Review of the Literature. Ophthalmology 2022; 129:e114-e126. [PMID: 36058739 DOI: 10.1016/j.ophtha.2022.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature. CLINICAL RELEVANCE Health care disparities continue to plague the nation's well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age). METHODS A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms "barriers and facilitators to health care," "access," and "disparities in general and sub-specialty eye care." Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria. RESULTS Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH. CONCLUSIONS The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.
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Affiliation(s)
- Sharon D Solomon
- School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Ruth Y Shoge
- School of Optometry, University of California Berkeley, Berkeley, California
| | - Ann Margret Ervin
- School of Medicine, Johns Hopkins University, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Melissa Contreras
- College of Optometry, Marshall B. Ketchum University, Fullerton, California
| | | | - Ugochi T Aguwa
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mildred M G Olivier
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
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Increased Distance from Clinic Leads to Higher Loss to Follow-up after Pars Plana Vitrectomy in Diabetic Patients. Retina 2022; 42:1921-1925. [DOI: 10.1097/iae.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Cai CX, Li Y, Zeger SL, McCarthy ML. Social determinants of health impacting adherence to diabetic retinopathy examinations. BMJ Open Diabetes Res Care 2021; 9:e002374. [PMID: 34583972 PMCID: PMC8479983 DOI: 10.1136/bmjdrc-2021-002374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations. RESEARCH DESIGN AND METHODS This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment. RESULTS Of the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment. CONCLUSIONS A multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.
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Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Scott L Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melissa L McCarthy
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Watane A, Kalavar M, Vanner EA, Cavuoto K, Sridhar J. FOLLOW-UP ADHERENCE IN PATIENTS WITH NONPROLIFERATIVE DIABETIC RETINOPATHY PRESENTING TO AN OPHTHALMIC EMERGENCY DEPARTMENT. Retina 2021; 41:1293-1301. [PMID: 33252579 DOI: 10.1097/iae.0000000000003037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the rate of follow-up after emergent encounters for nonproliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up adherence. METHODS A retrospective cohort study of patients presenting to an ophthalmic emergency department with nonproliferative diabetic retinopathy between May 2014 and December 2018 was conducted. Demographic and encounter data were gathered. Adherence to follow-up was defined as a completed encounter within 5 weeks of the recommended follow-up. RESULTS A total of 1,248 patients were included. The overall follow-up rate was 53%. Significantly decreased odds of follow-up adherence were associated with longer physician recommended follow-up intervals (odds ratio: 0.81, P < 0.001), longer interval to scheduled appointment (OR: 0.98, P < 0.001), commercial insurance (OR: 0.76, P = 0.01), and lack of any insurance (OR: 0.57, P < 0.01). Significantly increased odds were associated with a longer emergency department visit duration (OR: 1.002, P = 0.001), farther home distance (1.02, P < 0.01), increased likelihood of living in a higher income area (OR: 1.07, P = 0.04), greater NPDR severity (OR: 1.23, P < 0.01), Medicare (OR: 1.38, P = 0.04), presence of macular edema (OR: 1.66, P < 0.001), and worse vision (OR: 1.73, P < 0.001). CONCLUSION Patients presenting emergently with non-proliferative diabetic retinopathy are at high risk for follow-up nonadherence. Several patient and encounter characteristics were associated with follow-up adherence.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Bastos de Carvalho A, Lee Ware S, Belcher T, Mehmeti F, Higgins EB, Sprang R, Williams C, Studts JL, Studts CR. Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study. Implement Sci Commun 2021; 2:54. [PMID: 34022946 PMCID: PMC8141191 DOI: 10.1186/s43058-021-00157-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients' perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. METHODS We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. RESULTS Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR's Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. CONCLUSIONS This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings.
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Affiliation(s)
- Ana Bastos de Carvalho
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA.
| | - S Lee Ware
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA
| | - Tamara Belcher
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA
| | - Franceska Mehmeti
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA
| | - Eric B Higgins
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA
| | - Rob Sprang
- Kentucky Telecare, University of Kentucky, Lexington, KY, USA
| | - Cody Williams
- Department of Ophthalmology and Visual Sciences, University of Kentucky, 110 Conn Terrace Ste 550, Lexington, KY, 40508, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO, USA
| | - Christina R Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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PATIENTS PRESENTING EMERGENTLY WITH PROLIFERATIVE DIABETIC RETINOPATHY: Follow-up and Factors Associated With Compliance. Retina 2021; 40:928-935. [PMID: 30897069 DOI: 10.1097/iae.0000000000002481] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the rate of follow-up after emergent encounters for proliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up compliance. METHODS A retrospective cohort study of patients presenting to an ophthalmic emergency department with active proliferative diabetic retinopathy between May 2014 and December 2016 was conducted. Demographic data and encounter data were gathered for each emergency department visit. Compliance with follow-up was defined as a completed clinic visit as scheduled after the emergency encounter. RESULTS A total of 590 emergency department encounters were included. The overall follow-up rate was 61.9%. Married patients and those with Public Health Trust insurance had increased odds of compliance (odds ratio [OR]: 1.507, P = 0.04; OR: 2.749, P < 0.0001). Patients with Medicaid had reduced odds (OR: 0.543, P = 0.004). Patients with longer emergency department encounters and longer intervals to follow-up had reduced odds (OR: 0.948, P = 0.001; OR of 0.941, P < 0.0001). The other characteristics were not significantly associated with follow-up compliance. CONCLUSION Patients who present emergently with active proliferative diabetic retinopathy are at high risk of following up noncompliance. Characteristics with significant effects on the odds of follow-up compliance include specific insurance payer, marriage status, length of visit, and interval to follow-up.
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Moustafa GA, Borkar DS, Eton EA, Koulisis N, Kloek CE. Healthcare disparities contribute to missed follow-up visits after cataract surgery in the USA: results from the perioperative care for intraocular lens study. BMJ Open 2021; 11:e038565. [PMID: 33737416 PMCID: PMC7978071 DOI: 10.1136/bmjopen-2020-038565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors. METHODS In this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded. RESULTS A total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age<30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70-79 years, estimated travel time of >2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50-20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90-20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits. CONCLUSIONS Medical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them.
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Affiliation(s)
- Giannis A Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Durga S Borkar
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA
| | - Emily A Eton
- W K Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Koulisis
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn E Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Ophthalmology, University of Oklahoma College of Medicine, Dean McGee Eye Institute, Oklahoma City, Oklahoma, USA
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Gange WS, Xu BY, Lung K, Toy BC, Seabury SA. Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes. Ophthalmol Retina 2020; 5:160-168. [PMID: 32653554 DOI: 10.1016/j.oret.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine rates of eye examinations and diabetic eye disease in the first 5 years after diagnosis of type 2 diabetes (DM2) among continuously insured adults. DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS Insured patients aged 40 years or older with newly diagnosed DM2 (n = 42 684), and control patients without diabetes matched on age, sex, and race were identified from a nationwide commercial claims database containing data from 2007 to 2015. METHODS All patients were tracked for 6 years: 1 year before and 5 years after the index diabetes diagnosis. Receipt of eye care for individual patients was identified using International Classification of Diseases 9th edition (ICD-9) procedure codes or Current Procedural Terminology (CPT) codes indicating an eye examination, as well as encounters indicating the patient was seen by an ophthalmologist. A diagnosis of diabetic eye disease was determined by using ICD-9 codes. MAIN OUTCOME MEASURES Outcome measures included annual receipt of eye care and development of diabetic eye disease, namely, diabetic retinopathy (DR). Associations between these outcomes and demographic factors were tested with multivariable logistic regression. RESULTS Diabetic patients received more eye examinations than controls in each year, but no more than 40.4% of diabetic patients received an examination in any given year. Patients with Medicare Advantage received fewer eye examinations at 5 years (odds ratio [OR], 0.79; P < 0.01) than those with private insurance but were less likely to develop DR (OR, 0.71; P < 0.01). Hispanic patients had higher rates of DR (OR, 1.60; P < 0.01) and received fewer eye examinations (OR, 0.75; P < 0.01) at 5 years compared with White patients. Men received fewer eye examinations (OR, 0.84; P < 0.01) and were more likely to develop DR at 5 years (OR, 1.17; P < 0.01) than women. Patients with higher education were more likely to receive an eye examination and less likely to develop DR. CONCLUSIONS The majority of diabetic patients do not receive adequate eye care within the 5 years after initial diabetes diagnosis despite having insurance. Efforts should be made to improve adherence to screening guidelines, especially for vulnerable populations.
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Affiliation(s)
- William S Gange
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Khristina Lung
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian C Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Seth A Seabury
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
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Bradley ER, Delaffon V. Diabetic retinopathy screening in persons with mental illness: a literature review. BMJ Open Ophthalmol 2020; 5:e000437. [PMID: 32885049 PMCID: PMC7451277 DOI: 10.1136/bmjophth-2020-000437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
People living with severe mental illness (SMI) have an increased risk of developing diabetes and are less likely to spontaneously report physical health concerns; they may therefore derive greater benefit from attending screening to prevent diabetic retinopathy. We conducted a literature review to consider the uptake of diabetic retinopathy screening (DRS) in people with mental illness. People with a diagnosis of SMI and those with self-reported mental ill-health have reduced attendance at DRS, within the context of poorer compliance with general diabetic care. Anxiety and depression were noted as barriers in attending DRS. People living with SMI require additional support to benefit from preventative health programmes such as DRS. Further research could support a better understanding of barriers to attendance, allowing effective support systems to be developed.
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Affiliation(s)
- Elinor Rhian Bradley
- Ashford Community Mental Health Trust, Kent and Medway NHS and Social Care Partnership Trust, Ashford, UK
| | - Vijay Delaffon
- Willow Suite, Kent and Medway NHS and Social Care Partnership Trust, Dartford, UK
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Automated Reminders Improve Retinal Screening Rates in Low Income, Minority Patients with Diabetes and Correct the African American Disparity. J Med Syst 2019; 44:17. [DOI: 10.1007/s10916-019-1510-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
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Angermann R, Rauchegger T, Nowosielski Y, Casazza M, Bilgeri A, Ulmer H, Zehetner C. Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage. Graefes Arch Clin Exp Ophthalmol 2019; 257:2119-2125. [PMID: 31286206 DOI: 10.1007/s00417-019-04414-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyze and compare loss to follow-up (LTFU) rates between patients with diabetic retinopathy (DR) and those with neovascular age-related macular degeneration (nAMD) in patients, receiving treatment with anti-vascular endothelial growth factor (VEGF), under universal health coverage. METHODS We retrospectively analyzed the relevant data of 1264 patients receiving anti-VEGF therapy, in this cohort study. The observation period ranged from September 01, 2015 to December 31, 2018. Intervals between each procedure and the subsequent follow-up examination were measured. Demographic data, visual acuity (VA), the type of transport for treatment access, and distance between the residence and clinic were evaluated as risk factors for LTFU. RESULTS We collected data for 841 patients with nAMD (age, 81.0 (± 8.1 years)) and 423 patients with DR (age, 67.7 (± 12.1 years)). The rate of LTFU, for at least 6 months, was 28.8% and 2.9% for patients with DR and nAMD, respectively (p < 0.001). In the DR group, 18.9% patients were lost to follow-up exceeding > 12 months. Multivariate regression analysis showed that advanced age, lack of mobility, and need for assisted transport, poor final VA despite treatment, and decrease in vision during the observational period were independent risk factors for LTFU exceeding 12 months (p < 0.05). CONCLUSIONS We found a high long-term LTFU rate for patients with DR, despite treatment under universal health coverage. Considering the risk of disease progression, particularly in patients with chronic DR, strategies for better compliance and adherence to therapy should be considered for optimized patient care.
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Affiliation(s)
- Reinhard Angermann
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Teresa Rauchegger
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Marina Casazza
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Angelika Bilgeri
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Eppley SE, Mansberger SL, Ramanathan S, Lowry EA. Characteristics Associated with Adherence to Annual Dilated Eye Examinations among US Patients with Diagnosed Diabetes. Ophthalmology 2019; 126:1492-1499. [PMID: 31281055 DOI: 10.1016/j.ophtha.2019.05.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/03/2019] [Accepted: 05/31/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To identify the characteristics that are associated with adherence to annual diabetic eye exams and patient awareness of retinopathy using a nationally representative sample from the United States. DESIGN Cross-sectional, secondary analysis. PARTICIPANTS National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2016 aged 20 years and older with diabetes mellitus. METHODS The NHANES collected surveys every 2 years from 2005 to 2016, which contained demographic information, clinical information, and time to last dilated eye exam. From 2005 to 2008, retinal photographs were taken of all participants older than 40 years of age. We used univariate and multivariable logistic regression to determine the demographic and clinical factors associated with adherence to annual diabetic eye examinations and those associated with correctly reporting their retinopathy status. MAIN OUTCOME MEASURE Factors associated with adherence defined as having an eye exam within the preceding 12 or 24 months. RESULTS From 2005 to 2016, NHANES surveyed 4072 individuals who represent 20 million Americans aged 20 years and older with self-report of diabetes. By using the adherence definitions of 12 and 24 months, 63.4% and 78.7%, respectively, were adherent to diabetic eye examinations. The nonadherence rates of 36.6% and 21.3% for this national estimate did not change from 2005 to 2016 (P = 0.7, logistic regression). Insurance status, age, education, income, cholesterol levels, duration of diabetes, and self-reported retinopathy were all significantly associated with adherence with both definitions (all P < 0.05, logistic regression). Insurance status had the highest predictive value, with 76% of Americans on combination private-public insurance adherent compared with 36% of uninsured. Most Americans with retinopathy incorrectly denied having the diagnosis (2 727 144/3 896 093 or 70%). CONCLUSIONS Multiple variables were associated with nonadherence to eye exams, with insurance status having the strongest association. Adherence with annual eye exams has not improved over the past decade. The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year. Further improvements in education and adherence may reduce the visual morbidity caused by diabetes.
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Affiliation(s)
- Sarah E Eppley
- School of Medicine, University of California, San Francisco, California
| | | | - Saras Ramanathan
- Department of Ophthalmology, University of California, San Francisco, California
| | - Eugene A Lowry
- Devers Eye Institute, Legacy Health System, Portland, Oregon; Casey Eye Institute, Oregon Health and Sciences University, Portland, Oregon.
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Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA. United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. Br J Ophthalmol 2019; 103:837-843. [PMID: 30269098 PMCID: PMC6582816 DOI: 10.1136/bjophthalmol-2018-312568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. METHODS This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. RESULTS 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). CONCLUSIONS This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
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Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Aaron Y Lee
- University of Washington, Seattle, Washington, USA
| | | | | | - Clare Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peck-Lin Lip
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, UK
| | - Esther Cook
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK
| | | | | | | | - Randhir Chavan
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | | | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Centre at Bedford Hospital, Bedford, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | | | - Helen Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Bobby Paul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Dawn A Sim
- Moorfields Eye Centre at Croydon University Hospital, London, UK
| | | | | | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
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Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Zuurmond M, Peto T, Gordon I, Hewage S, Kamalakannan S. Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings. PLoS One 2019; 14:e0198979. [PMID: 31013274 PMCID: PMC6478270 DOI: 10.1371/journal.pone.0198979] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) can lead to visual impairment and blindness if not detected and treated in time. Knowing the barriers/enablers in advance in contrasting different country income settings may accelerate development of a successful DR screening (DRS) program. This would be especially applicable in the low-income settings with the rising prevalence of DR. OBJECTIVES The aim of this systematic review is to identify and contrast the barriers/enablers to DRS for different contexts using both consumers i.e., people with diabetes (PwDM) and provider perspectives and system level factors in different country income settings. METHODS We searched MEDLINE, Embase, CENTRAL in the Cochrane Library from the databases start date to December 2018. We included the studies reported on barriers and enablers to access DRS services based at health care facilities. We categorised and synthesized themes related to the consumers (individuals), providers and the health systems (environment) as main dimensions according to the constructs of social cognitive theory, supported by the quantitative measures i.e., odds ratios as reported by each of the study authors. MAIN RESULTS We included 77 studies primarily describing the barriers and enablers. Most of the studies were from high income settings (72.7%, 56/77) and cross sectional in design (76.6%, 59/77). From the perspectives of consumers, lack of knowledge, attitude, awareness and motivation were identified as major barriers. The enablers were fear of blindness, proximity of screening facility, experiences of vision loss and being concerned of eye complications. In providers' perspectives, lack of skilled human resources, training programs, infrastructure of retinal imaging and cost of services were the main barriers. Higher odds of uptake of DRS services was observed when PwDM were provided health education (odds ratio (OR) 4.3) and having knowledge on DR (OR range 1.3-19.7). CONCLUSION Knowing the barriers to access DRS is a pre-requisite in development of a successful screening program. The awareness, knowledge and attitude of the consumers, availability of skilled human resources and infrastructure emerged as the major barriers to access to DRS in any income setting.
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Affiliation(s)
- Mapa Mudiyanselage Prabhath Nishantha Piyasena
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Gudlavalleti Venkata S. Murthy
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer L. Y. Yip
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Gilbert
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Zuurmond
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Faculty of Medicine, Health and Life Sciences, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, Northern Ireland
| | - Iris Gordon
- Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suwin Hewage
- Retina Unit, Department of Vitreo-retina, National Eye Hospital, Colombo, Sri Lanka
| | - Sureshkumar Kamalakannan
- Department of Eye Health and Disability, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
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Lawrenson JG, Graham-Rowe E, Lorencatto F, Rice S, Bunce C, Francis JJ, Burr JM, Aluko P, Vale L, Peto T, Presseau J, Ivers NM, Grimshaw JM. What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis. Health Technol Assess 2019; 22:1-160. [PMID: 29855423 DOI: 10.3310/hta22290] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetic retinopathy screening (DRS) is effective but uptake is suboptimal. OBJECTIVES To determine the effectiveness of quality improvement (QI) interventions for DRS attendance; describe the interventions in terms of QI components and behaviour change techniques (BCTs); identify theoretical determinants of attendance; investigate coherence between BCTs identified in interventions and determinants of attendance; and determine the cost-effectiveness of QI components and BCTs for improving DRS. DATA SOURCES AND REVIEW METHODS Phase 1 - systematic review of randomised controlled trials (RCTs) evaluating interventions to increase DRS attendance (The Cochrane Library, MEDLINE, EMBASE and trials registers to February 2017) and coding intervention content to classify QI components and BCTs. Phase 2 - review of studies reporting factors influencing attendance, coded to theoretical domains (MEDLINE, EMBASE, PsycINFO and sources of grey literature to March 2016). Phase 3 - mapping BCTs (phase 1) to theoretical domains (phase 2) and an economic evaluation to determine the cost-effectiveness of BCTs or QI components. RESULTS Phase 1 - 7277 studies were screened, of which 66 RCTs were included in the review. Interventions were multifaceted and targeted patients, health-care professionals (HCPs) or health-care systems. Overall, interventions increased DRS attendance by 12% [risk difference (RD) 0.12, 95% confidence interval (CI) 0.10 to 0.14] compared with usual care, with substantial heterogeneity in effect size. Both DRS-targeted and general QI interventions were effective, particularly when baseline attendance levels were low. All commonly used QI components and BCTs were associated with significant improvements, particularly in those with poor attendance. Higher effect estimates were observed in subgroup analyses for the BCTs of 'goal setting (outcome, i.e. consequences)' (RD 0.26, 95% CI 0.16 to 0.36) and 'feedback on outcomes (consequences) of behaviour' (RD 0.22, 95% CI 0.15 to 0.29) in interventions targeting patients and of 'restructuring the social environment' (RD 0.19, 95% CI 0.12 to 0.26) and 'credible source' (RD 0.16, 95% CI 0.08 to 0.24) in interventions targeting HCPs. Phase 2 - 3457 studies were screened, of which 65 non-randomised studies were included in the review. The following theoretical domains were likely to influence attendance: 'environmental context and resources', 'social influences', 'knowledge', 'memory, attention and decision processes', 'beliefs about consequences' and 'emotions'. Phase 3 - mapping identified that interventions included BCTs targeting important barriers to/enablers of DRS attendance. However, BCTs targeting emotional factors around DRS were under-represented. QI components were unlikely to be cost-effective whereas BCTs with a high probability (≥ 0.975) of being cost-effective at a societal willingness-to-pay threshold of £20,000 per QALY included 'goal-setting (outcome)', 'feedback on outcomes of behaviour', 'social support' and 'information about health consequences'. Cost-effectiveness increased when DRS attendance was lower and with longer screening intervals. LIMITATIONS Quality improvement/BCT coding was dependent on descriptions of intervention content in primary sources; methods for the identification of coherence of BCTs require improvement. CONCLUSIONS Randomised controlled trial evidence indicates that QI interventions incorporating specific BCT components are associated with meaningful improvements in DRS attendance compared with usual care. Interventions generally used appropriate BCTs that target important barriers to screening attendance, with a high probability of being cost-effective. Research is needed to optimise BCTs or BCT combinations that seek to improve DRS attendance at an acceptable cost. BCTs targeting emotional factors represent a missed opportunity to improve attendance and should be tested in future studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42016044157 and PROSPERO CRD42016032990. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- John G Lawrenson
- Centre for Applied Vision Research, School of Health Sciences, City, University of London,London,UK
| | - Ella Graham-Rowe
- Centre for Health Services Research, School of Health Sciences, City, University of London,London,UK
| | - Fabiana Lorencatto
- Centre for Health Services Research, School of Health Sciences, City, University of London,London,UK
| | - Stephen Rice
- Health Economics Group, Institute of Health and Society, Newcastle University,Newcastle upon Tyne,UK
| | - Catey Bunce
- Department of Primary Care & Public Health Sciences, King's College London,London,UK
| | - Jill J Francis
- Centre for Health Services Research, School of Health Sciences, City, University of London,London,UK
| | | | - Patricia Aluko
- Health Economics Group, Institute of Health and Society, Newcastle University,Newcastle upon Tyne,UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University,Newcastle upon Tyne,UK
| | - Tunde Peto
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast,Belfast,UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute,Ottawa, ON,Canada.,School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa,Ottawa, ON,Canada
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto,Toronto, ON,Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute,Ottawa, ON,Canada.,Department of Medicine, University of Ottawa,Ottawa, ON,Canada
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Graham-Rowe E, Lorencatto F, Lawrenson JG, Burr JM, Grimshaw JM, Ivers NM, Presseau J, Vale L, Peto T, Bunce C, J Francis J. Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature. Diabet Med 2018; 35:1308-1319. [PMID: 29790594 DOI: 10.1111/dme.13686] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS To identify and synthesize studies reporting modifiable barriers/enablers associated with retinopathy screening attendance in people with Type 1 or Type 2 diabetes, and to identify those most likely to influence attendance. METHODS We searched MEDLINE, EMBASE, PsycINFO, Cochrane Library and the 'grey literature' for quantitative and qualitative studies to February 2017. Data (i.e. participant quotations, interpretive summaries, survey results) reporting barriers/enablers were extracted and deductively coded into domains from the Theoretical Domains Framework; with domains representing categories of theoretical barriers/enablers proposed to mediate behaviour change. Inductive thematic analysis was conducted within domains to describe the role each domain plays in facilitating or hindering screening attendance. Domains that were more frequently coded and for which more themes were generated were judged more likely to influence attendance. RESULTS Sixty-nine primary studies were included. We identified six theoretical domains ['environmental context and resources' (75% of included studies), 'social influences' (51%), 'knowledge' (51%), 'memory, attention, decision processes' (50%), 'beliefs about consequences' (38%) and 'emotions' (33%)] as the key mediators of diabetic retinopathy screening attendance. Examples of barriers populating these domains included inaccurate diabetic registers and confusion between routine eye care and retinopathy screening. Recommendations by healthcare professionals and community-level media coverage acted as enablers. CONCLUSIONS Across a variety of contexts, we found common barriers to and enablers of retinopathy screening that could be targeted in interventions aiming to increase screening attendance.
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Affiliation(s)
- E Graham-Rowe
- Psychology Applied to Health Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
- School of Health Sciences, Centre for Applied Vision Research, City University of London
- School of Health Sciences, Centre for Health Services Research, City University of London
| | - F Lorencatto
- Centre for Behaviour Change, University College London, London, UK
| | - J G Lawrenson
- School of Health Sciences, Centre for Applied Vision Research, City University of London
| | - J M Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J M Grimshaw
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - N M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, Canada
| | - J Presseau
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - L Vale
- Institute of Health and Society, Health Economics Group, Newcastle University, Newcastle upon Tyne, UK
| | - T Peto
- School of Medicine, Dentistry and Biomedical Sciences, Queens University of Belfast, UK
| | - C Bunce
- Department of Primary Care and Public Health Sciences, King's College London, UK
| | - J J Francis
- School of Health Sciences, Centre for Health Services Research, City University of London
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24
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Lake AJ, Browne JL, Abraham C, Tumino D, Hines C, Rees G, Speight J. A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes - an intervention mapping approach. BMC Health Serv Res 2018; 18:396. [PMID: 29855307 PMCID: PMC5984467 DOI: 10.1186/s12913-018-3188-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/04/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Young adults (18-39 years) with type 2 diabetes are at risk of early development and rapid progression of diabetic retinopathy, a leading cause of vision loss and blindness in working-age adults. Retinal screening is key to the early detection of diabetic retinopathy, with risk of vision loss significantly reduced by timely treatment thereafter. Despite this, retinal screening rates are low among this at-risk group. The objective of this study was to develop a theoretically-grounded, evidence-based retinal screening promotion leaflet, tailored to young adults with type 2 diabetes. METHODS Utilising the six steps of Intervention Mapping, our multidisciplinary planning team conducted a mixed-methods needs assessment (Step 1); identified modifiable behavioural determinants of screening behaviour and constructed a matrix of change objectives (Step 2); designed, reviewed and debriefed leaflet content with stakeholders (Steps 3 and 4); and developed program implementation and evaluation plans (Steps 5 and 6). RESULTS Step 1 included in-depth qualitative interviews (N = 10) and an online survey that recruited a nationally-representative sample (N = 227), both informed by literature review. The needs assessment highlighted the crucial roles of knowledge (about diabetic retinopathy and screening), perception of personal risk, awareness of the approval of significant others and engagement with healthcare team, on retinal screening intentions and uptake. In Step 2, we selected five modifiable behavioural determinants to be targeted: knowledge, attitudes, normative beliefs, intention, and behavioural skills. In Steps 3 and 4, the "Who is looking after your eyes?" leaflet was developed, containing persuasive messages targeting each determinant and utilising engaging, cohort-appropriate imagery. In Steps 5 and 6, we planned Statewide implementation and designed a randomised controlled trial to evaluate the leaflet. CONCLUSIONS This research provides an example of a systematic, evidence-based approach to the development of a simple health intervention designed to promote uptake of screening in accordance with national guidelines. The methods and findings illustrate how Intervention Mapping can be employed to develop tailored retinal screening promotion materials for specific priority populations. This paper has implications for future program planners and is intended to assist those wishing to use Intervention Mapping to create similar theoretically-driven, tailored resources.
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Affiliation(s)
- Amelia J. Lake
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jessica L. Browne
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Charles Abraham
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Dee Tumino
- Vision 2020 Australia, Melbourne, Australia
| | | | - Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002 Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3010 Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- AHP Research, Hornchurch, UK
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25
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Lake AJ, Rees G, Speight J. Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults with Type 2 Diabetes. Curr Diab Rep 2018; 18:41. [PMID: 29797076 DOI: 10.1007/s11892-018-1007-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Young adults with type 2 diabetes (T2D, 18-39 years) experience early-onset and rapid progression of diabetic retinopathy (DR), the leading cause of vision loss for working age adults. Despite this, uptake of retinal screening, the crucial first step in preventing vision loss from DR, is low. The aim of this review is to summarize the clinical and psychosocial factors affecting uptake of retinal screening. RECENT FINDINGS Barriers include lack of diabetes-related symptoms, low personal DR risk perception, high rates of depression and diabetes-related distress, fatalism about inevitability of complications, time and financial constraints, disengagement with existing diabetes self-management services, and perceived stigma due to having a condition associated with older adults. Young adults with T2D are an under-researched population who face an accumulation of barriers to retinal screening. Tailored interventions that address the needs, characteristics, and priorities of young adults with T2D are warranted.
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Affiliation(s)
- A J Lake
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, c/- 570 Elizabeth Street, Melbourne, VIC, 3000, Australia.
| | - G Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3010, Australia
| | - J Speight
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, c/- 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- AHP Research, Hornchurch, UK
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26
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An J, Niu F, Turpcu A, Rajput Y, Cheetham TC. Adherence to the American Diabetes Association retinal screening guidelines for population with diabetes in the United States. Ophthalmic Epidemiol 2018; 25:257-265. [PMID: 29333897 DOI: 10.1080/09286586.2018.1424344] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE (1) To assess long-term adherence to American Diabetes Association guideline-recommended retinal screening among population with diabetes in the United States. (2) To determine factors associated with long-term adherence to routine eye screening exams. METHODS A retrospective cohort study was conducted in adult patients with diabetes identified from January 2009 to December 2010. Patients were followed until disenrollment, death, or study end date (December 2013). A patient was defined as adherent when having at least one exam in each 12-month period if there was evidence of retinopathy, or at least one exam in each 24-month period if there was no evidence of retinopathy. Multivariate logistic regressions were used to investigate patient demographics and other baseline characteristics associated with adherence to guidelines. RESULTS A total of 204,073 patients were identified; the mean age (SD) was 61 (13) years and 48% were female. Overall, 71.1% were adherent to the retinal screening guidelines during a median of 4.8 years of follow-up including 27.7% who received an eye exam every year. Patient socioeconomic status (younger age, black race, lower income/education), less comorbidity, insulin use, higher specialist copayment plans, and proxies for poor patient behavior (lower adherence to the oral hypoglycemic agents, less diabetes education, hemoglobin A1C >9%) were associated with nonadherence to routine eye screening exams. CONCLUSION During nearly 5 years of follow-up, 28.9% of patients with diabetes were nonadherent to the retinal screening guidelines. Future research should focus on the development of interventions to address modifiable factors associated with nonadherence.
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Affiliation(s)
- JaeJin An
- a Department of Pharmacy Practice & Administration , Western University of Health Sciences , Pomona , CA , USA
| | - Fang Niu
- b Drug Information Services, Kaiser Permanente Southern California, Downey , CA , USA
| | - Adam Turpcu
- c Healthcare Economics Unit, Genentech Inc., South San Friancisco , CA , USA
| | - Yamina Rajput
- c Healthcare Economics Unit, Genentech Inc., South San Friancisco , CA , USA
| | - T Craig Cheetham
- a Department of Pharmacy Practice & Administration , Western University of Health Sciences , Pomona , CA , USA.,d Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
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27
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Mwangi N, Macleod D, Gichuhi S, Muthami L, Moorman C, Bascaran C, Foster A. Predictors of uptake of eye examination in people living with diabetes mellitus in three counties of Kenya. Trop Med Health 2017; 45:41. [PMID: 29299019 PMCID: PMC5740562 DOI: 10.1186/s41182-017-0080-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a significant public health concern that is potentially blinding. Clinical practice guidelines recommend annual eye examination of patients with diabetes for early detection of DR. Our aim was to identify the demand-side factors that influence uptake of eye examination among patients already utilizing diabetes services in three counties of Kenya. METHODS We designed a clinic based cross-sectional study and used three-stage sampling to select three counties, nine diabetes clinics in these counties and 270 patients with diabetes attending these clinics. We interviewed the participants using a structured questionnaire. The two outcomes of interest were 'eye examination in the last 12 months' and 'eye examination ever'. The exposure variables were the characteristics of participants living with diabetes. RESULTS The participants had a mean age of 53.3 years (SD 14.1) and an average interval of 4 months between visits to the diabetes clinic. Only 25.6% of participants had ever had an eye examination in their lifetime, while 13.3% had it in the preceding year. The independent predictors of uptake were referral by diabetes services, patient knowledge of diabetes eye complications, comorbid hypertension and urban or semi-urban residence. CONCLUSIONS We conclude that access to retinal examination for DR is low in all three counties. An intervention that increases the knowledge of patients with diabetes about eye complications and promotes referral of patients with diabetes for eye examination may improve access to annual eye examination for DR.
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Affiliation(s)
- Nyawira Mwangi
- London School of Hygiene and Tropical Medicine, London, UK
- Kenya Medical Training College, Nairobi, Kenya
| | - David Macleod
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Allen Foster
- London School of Hygiene and Tropical Medicine, London, UK
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28
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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29
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Zou YH, Li Q, Cui SS, Jia W, Zhang N, Ma K, Snellingen T, Liu XP. Predictors for attending annual eye screening for diabetic retinopathy amongst patients with diabetes in an urban community of Beijing. Int J Ophthalmol 2017; 10:1144-1149. [PMID: 28730119 DOI: 10.18240/ijo.2017.07.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/10/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To gain a better understanding of possible factors that may influence the decision of diabetes persons to participate in annual eye screening in an urban community setting of China. METHODS A structured interview including questions on attendance of eye screening, knowledge and awareness of diabetic retinopathy was conducted. The presence and degree of retinopathy were assessed using two field non-mydriatic retinal photography. RESULTS Totally 720 diabetes persons were recruited and 519 were enrolled in this cross-sectional study. In this urban setting of Beijing, among diabetes patients of average of 10y duration, 77% confirmed having undergone at least one eye examination and 61% reported having at least one eye examination with dilated pupil. As for the last 12mo, the number decreased to 210 (47%) and 131 (30%) separately. Most of the participants (95%) were aware that diabetes could affect their vision and that regular eye examination was necessary. Very few of them (12%) however were aware that the early stages of diabetic retinopathy presented without symptoms of vision loss. Having attended patient education on diabetes was effective in building awareness about diabetic eye disease and was a significant positive predictor for attending eye screening [education in a year, Adj. OR=0.47 (0.29-0.74), P<0.001, education years ago, Adj. OR=0.56 (0.33-0.96), P=0.036]. The duration of disease also increased the likelihood of having undergone eye screening (Adj. OR=0.96, P<0.05). CONCLUSION Being exposed to education about the complications of diabetes increases the probability of attending diabetic eye screening. An appropriate patient knowledge building strategy should be made available to patients from the time of diagnosis.
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Affiliation(s)
- Yan-Hong Zou
- Beijing Huaxin Hospital, the First Hospital of Tsinghua University, Beijing 100016, China.,Tsinghua University Medical Center, Beijing 100084, China
| | - Qian Li
- Beijing Huaxin Hospital, the First Hospital of Tsinghua University, Beijing 100016, China.,Tsinghua University Medical Center, Beijing 100084, China
| | - Shan-Shan Cui
- Beijing Huaxin Hospital, the First Hospital of Tsinghua University, Beijing 100016, China
| | - Wei Jia
- Sekwa Eye Hospital, Sekwa Institute of Medicine, Beijing 100088, China
| | - Ning Zhang
- Beijing Huaxin Hospital, the First Hospital of Tsinghua University, Beijing 100016, China
| | - Kai Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Torkel Snellingen
- Sekwa Eye Hospital, Sekwa Institute of Medicine, Beijing 100088, China
| | - Xi-Pu Liu
- Beijing Huaxin Hospital, the First Hospital of Tsinghua University, Beijing 100016, China.,Sekwa Eye Hospital, Sekwa Institute of Medicine, Beijing 100088, China
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30
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Bodduluri L, Boon MY, Ryan M, Dain SJ. Impact of Gamification of Vision Tests on the User Experience. Games Health J 2017; 6:229-236. [PMID: 28691854 DOI: 10.1089/g4h.2016.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Gamification has been incorporated into vision tests and vision therapies in the expectation that it may increase the user experience and engagement with the task. The current study aimed to understand how gamification affects the user experience, specifically during the undertaking of psychophysical tasks designed to estimate vision thresholds (chromatic and achromatic contrast sensitivity). METHODS Three tablet computer-based games were developed with three levels of gaming elements. Game 1 was designed to be a simple clinical test (no gaming elements), game 2 was similar to game 1 but with added gaming elements (i.e., feedback, scores, and sounds), and game 3 was a complete game. Participants (N = 144, age: 9.9-42 years) played three games in random order. The user experience for each game was assessed using a Short Feedback Questionnaire. RESULTS The median (interquartile range) fun level for the three games was 2.5 (1.6), 3.9 (1.7), and 2.5 (2.8), respectively. Overall, participants reported greater fun level and higher preparedness to play the game again for game 2 than games 1 and 3 (P < 0.05). There were significant positive correlations observed between fun level and preparedness to play the game again for all the games (p < 0.05). Engagement (assessed as completion rates) did not differ between the games. CONCLUSION Gamified version (game 2) was preferred to the other two versions. Over the short term, the careful application of gaming elements to vision tests was found to increase the fun level of users, without affecting engagement with the vision test.
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Affiliation(s)
- Lakshmi Bodduluri
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
| | - Mei Ying Boon
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
| | - Malcolm Ryan
- 2 Department of Computing, Macquarie University , Sydney, Australia
| | - Stephen J Dain
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
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Duan F, Liu Y, Chen X, Congdon N, Zhang J, Chen Q, Chen L, Chen X, Zhang X, Yu C, Liu Y. Influencing factors on compliance of timely visits among patients with proliferative diabetic retinopathy in southern China: a qualitative study. BMJ Open 2017; 7:e013578. [PMID: 28348188 PMCID: PMC5372015 DOI: 10.1136/bmjopen-2016-013578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To identify the reasons for low adherence among patients with diabetic retinopathy (DR) in southern China using a qualitative method. METHODS Exploratory indepth interviews were conducted in 27 diabetic patients with proliferative diabetic retinopathy who required vitrectomy surgery at Zhongshan Ophthalmic Centre, Sun Yat-sen University, from March to August 2015. Qualitative data analysis and research software (ATLAS.ti7) was used for data processing and analysis. RESULTS Factors influencing the occurrence of timely visits included lack of DR related knowledge, fear and worries about insulin, interactions between patients and society combined with the complexity of emotions and social culture, and the economic burden of treatment. CONCLUSIONS Although the reasons for low adherence involved social, emotional, cultural and economic factors, the key issue was the lack of awareness and knowledge of DR. Our findings have several practical implications for health policymakers and programme planners in China.
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Affiliation(s)
- Fang Duan
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Yuhong Liu
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Xiang Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Nathan Congdon
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Jian Zhang
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Qianyun Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Lingling Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Xi Chen
- Centre of Medical Anthropology and Behavioural Health, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Chengpu Yu
- Centre of Medical Anthropology and Behavioural Health, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
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Murchison AP, Hark L, Pizzi LT, Dai Y, Mayro EL, Storey PP, Leiby BE, Haller JA. Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res Care 2017; 5:e000333. [PMID: 28878930 PMCID: PMC5574424 DOI: 10.1136/bmjdrc-2016-000333] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes. DESIGN AND METHODS A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit. RESULTS Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index. CONCLUSIONS Patients with moderate to severe DR and/or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.
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Affiliation(s)
- Ann P Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lisa Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Dai
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Philip P Storey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Julia A Haller
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Callinan CE, Kenney B, Hark LA, Murchison AP, Dai Y, Leiby BE, Mayro EL, Bilson J, Haller JA. Improving Follow-Up Adherence in a Primary Eye Care Setting. Am J Med Qual 2016; 32:73-79. [PMID: 26656245 DOI: 10.1177/1062860615616860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lack of patient adherence with eye appointments can decrease ocular outcomes. This prospective, randomized, single-blinded controlled study assessed the effectiveness of multiple interventions in improving follow-up adherence to recommended eye appointments. Patients due for follow-up appointments were randomly assigned to usual care, automated intervention, or personal intervention. Automated-intervention patients and personal-intervention patients received a call one month prior to the recommended follow-up date, and a mailed appointment reminder letter. The call was automated for automated-intervention patients and personalized for personal-intervention patients. The primary outcome was adherence to the follow-up appointment. The secondary outcome was rate of appointment scheduling. Patients in the personal-intervention group had greater adherence to follow-up recommendations (38%) than patients in the usual care group (28%) and the automated-intervention group (30%). Personal intervention significantly increased appointment scheduling (51%) over usual care (32%) and automated intervention (36%). These results support systems-level changes to improve patient follow-up adherence in urban primary eye care settings.
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Affiliation(s)
| | | | - Lisa A Hark
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Yang Dai
- 1 Wills Eye Hospital, Philadelphia, PA
| | | | | | | | - Julia A Haller
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Quality of medical care for persons with serious mental illness: A comprehensive review. Schizophr Res 2015; 165:227-35. [PMID: 25936686 PMCID: PMC4670551 DOI: 10.1016/j.schres.2015.04.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research. METHODS Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers. RESULTS Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the overall US population. CONCLUSIONS Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and examine whether adherence to clinical guidelines leads to improved health and disability outcomes in this vulnerable group.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States.
| | - Julia Baller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States.
| | | | - Denise Juliano-Bult
- Johns Hopkins Medical Institutions, Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, United States.
| | - Gail L Daumit
- Johns Hopkins Medical Institutions, Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, United States.
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Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology 2014; 121:2452-60. [PMID: 25208856 PMCID: PMC4338994 DOI: 10.1016/j.ophtha.2014.07.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/24/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). DESIGN Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). PARTICIPANTS The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. METHODS Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. MAIN OUTCOME MEASURES The primary outcome measure was the number of 15-month periods with an eye examination. RESULTS One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. CONCLUSIONS Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.
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Affiliation(s)
- Frank A Sloan
- Department of Economics, Duke University, Durham, North Carolina.
| | | | - Yiqun Chen
- Department of Economics, Duke University, Durham, North Carolina
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Cotch MF, Freeman EE. Health care services: addressing the global challenge of universal eye health. Ophthalmic Epidemiol 2013; 20:255-7. [PMID: 24007494 DOI: 10.3109/09286586.2013.823217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health , Bethesda, MD , USA and
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