Effectiveness of a clinic-based intervention to improve follow-up adherence to vision care in patients with diabetes

Introduction: Diabetic retinopathy is the leading cause of blindness among adults aged 20-74 years. However, only about 50% of diabetics follow up with recommended dilated fundus examinations (DFE). Therefore, we implemented a clinic-based intervention to improve adherence to DFEs among these patients. Methods: In a randomized trial, diabetic patients who were due for a follow-up DFE, were assigned to receive 1) a single-mailed reminder letter (control group) or 2) a clinic-based intervention that consisted of a reminder letter plus an educational brochure, followed by a telephone call to schedule the DFE. Barriers to care utilization were captured. The primary outcome was completion of a DFE. Results: 522 patients were randomly assigned (control group n=260, intervention group n=262). Participants in both groups were similar with regards to gender, race, and age; female (66%), African-American (70%), mean age (61 years). Patients in the intervention group were more likely to schedule an appointment (68% vs. 44%; relative risk 1.55; 95% confidence interval 1.29-1.79; p <0.0001) compared to controls. Patients in the intervention group were equally likely to keep their appointment once scheduled compared to the control group (73.3% vs. 71.3%; p =0.71). Among those who did not make an appointment, common reported barriers included lack of time due to appointments for other medical conditions and no health insurance. Conclusions: A clinic-based intervention, which includes reminder letters, educational brochure, and appointment calls, significantly improves DFE adherence in patients with diabetes.