Alternative Access to Comprehensive Healthcare Via Intake by Eye Care Providers

Access to healthcare in diabetic and prediabetic patients is an important issue. Recent studies, including our own, have suggested that the majority of individuals with diabetes or prediabetes are either unaware of all of the issues present in their case, or do not currently have active treatment. Since hypertension and hyperlipidemia are frequent co-morbidities in these patients, this population has a group of important health issues that require ongoing attention. Studies have shown that Americans are more concerned with their vision, and are more likely to see an eye care provider annually than another type of healthcare provider. Therefore, we designed this study to determine if the intake of unselected patients by eye care providers might yield a group of patients at high risk for these medical conditions and improve their access to care. We assessed the prevalence of hyperglycemia, hypertension and hyperlipidemia in patients who responded to a free program administered by eye care providers in Columbus, Georgia. 2000 subjects were recruited for this program of eye examination and refraction. Using an easy-to-administer risk profile of waist circumference, family history, the presence of arcus senilis or diabetic retinopathy, and blood pressure measurement, 973 ( 49%) were referred for further, metabolic, point-of-service testing. 620 (64%) were actually tested. Subjects (Ss) were assessed for fasting blood sugar, lipid profile, and hemoglobin A1c determination. 216 (34.8%) had abnormal blood sugars. 60.6% of these did not know they had some form of hyperglycemia. 432 (69.6%) had hypertension, and 188 (43.5%) were unaware of this health issue. 454 (73%) had an abnormality of lipid metabolism and 249 (54.8%) were unaware of this problem. 284 Ss had arcus senilis (45.7%) and 13 (2.1%) had diabetic retinopathy. No Ss knew about the presence of arcus or retinopathy. Making detailed metabolic testing available to persons who were recruited for the program at no cost was associated with an overall failure rate for metabolic testing of 353 of 973 Ss (36.2%). When a subset of Ss were offered a voucher for free eye glasses upon completion of metabolic testing, the participation failure rate dropped to 31 of 267 (11.6%). We conclude that taking advantage of the concern of the public about their vision, and the creative use of eye care providers, can be associated with an effective alternate mechanism of intake of patients at high risk for chronic metabolic disease into active health care.