270549 Eye care utilization by patients with diabetes: A retrospective analysis targeted to improve follow-up adherence

Monday, October 29, 2012 : 2:30 PM - 2:45 PM

Ann P. Murchison, MD, MPH , Department of Research, Wills Eye Institute, Philadelphia, PA
Yang Dai, MS , Research, Wills Eye Institute, Philadelphia, PA
Benjamin Leiby, PhD , Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA
Lisa A. Hark, PhD, RD , Glaucoma Research Center, Wills Eye Institute, Philadelphia, PA
Laura Pizzi, PharmD, MPH , School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
Julia A. Haller, MD , Ophthalmologist-in-Chief, Wills Eye Institute, Philadelphia, PA
Background: Diabetic retinopathy (DR) is a leading cause of visual impairment with prevalence expected to triple by 2050. Annual eye exams are recommended for all people with diabetes, yet adherence is less than 60%. This lack of diabetic eye care leads to preventable visual problems and costly public health burdens. Objective: To evaluate utilization of eye care by patients with diabetes and factors that impact adherence. Methods: We conducted a 4-year retrospective analysis integrating electronic billing and chart data. We included patients with diabetes ≥40 years seen at the Wills Eye Institute (WEI) between 1/1/2007-12/31/2010. Analysis was adjusted for DR severity, co-morbid conditions, smoking status, time since diabetes diagnosis, hemoglobin A1c, insurer(s), and recommended follow-up. Multivariate analysis examined the association between these variables and adherence to follow-up. Results: Of 1252 charts reviewed, the majority of patients (74.4%) had mild DR. 75% were recommended for annual follow-up while 20% were recommended to follow-up within 3 months. Adherence to annual follow-up was 38% and 62% in the 3-month group. Multivariate analysis demonstrated statistically significant association between severity of DR (p<0.01), age (p<0.01), and smoking status (p<0.01) to adherence. Conclusion: Patients with mild DR, age ≤55 years, and smokers were least likely to adhere to follow-up. This data was used to inform and design a prospective intervention to improve adherence to follow-up in patients with diabetes at WEI. This intervention will be assessed in relation to usual care for a possible systems-level change to improve adherence to eye care in people with diabetes.

Learning Areas:
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify system-level and individual-level factors that impact access to and quality of vision care in patients with diabetes. Understand adherence to DFE follow-up and its relationship to demographics, ethnicity, socioeconomic status, primary care provider communication, ocular and medical co-morbidities.

Keywords: Vision Care, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-investigator multiple funded grants that focus on diabetic screening guidelines and adherence to eye care for people with diabetes. My scientific interests and ongoing research includes disparities in care utilization and I have a demonstrated record of training in both eye care and public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.