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Abstract
Introduction Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients’ adherence to postscreening recommendations.
Research design/methods A retrospective record review was conducted in primary care clinics of a large county hospital in the USA. All patients with diabetes detected with VTDR in two time periods, differing in record type used, were included in the study: 2012–2014, paper charts only; 2015–2017, combined paper charts/electronic medical records (EMRs), or EMRs only. Adherence rates for keeping initial ophthalmology appointments, starting recommended treatments, and keeping follow-up appointments were determined.
Results Adequate records were available for 6046 patients; 408 (7%) were detected with VTDR and recommended for referral to ophthalmology. Only 5% completed a first ophthalmology appointment within recommended referral interval, 15% within twice the recommended interval, and 51% within 1 year of DRS. Patients screened in 2015–2017 were more likely to complete a first ophthalmology appointment than those in 2012–2014. Ophthalmic treatment was recommended in half of the patients, of whom 94% initiated treatment. A smaller percentage (41%) adhered completely to post-treatment follow-up. Overall, 28% of referred patients: (1) kept a first ophthalmology appointment; (2) were recommended for treatment; and (3) initiated the treatment. Most patients failing to keep first ophthalmology appointments continued non-ophthalmic medical care at the institution. EMRs provided more complete information than paper charts.
Conclusions Reducing vision impairment from VTDR requires greater emphasis on timely adherence to ophthalmology referral and follow-up. Prevention of visual loss from VTDR starts with retinopathy screening, but must include patient engagement, adherence monitoring, and streamlining ophthalmic referral and management. Revision of these processes has already been implemented at the study site, incorporating lessons from this investigation.
- compliance/adherence
- retinopathy screening
- primary care
- ophthalmology
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Footnotes
Presented at A modified abstract of this manuscript was accepted for presentation at the annual meeting of the Association for Research in Vision and Ophthalmology in Baltimore, MD, from 3 to 7 May 2020.
Contributors GB designed the study protocol, researched the data, contributed to discussion, drafted the manuscript, and reviewed and edited the manuscript. JAC helped design the study protocol, researched the data, contributed to discussion, and reviewed and edited the manuscript. PC and AL researched the data, contributed to discussion, and reviewed and edited the manuscript. SF, ERP, GW, and MK contributed to discussion, and reviewed and edited the manuscript. JC and LJ conducted the statistical analyses and reviewed and edited the manuscript. GB is the guarantor of this work, and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the paper.
Funding This study was supported by Google and EyePACS.
Competing interests GB, JAC and PC declared competing interests based on EyePACS affiliation. SF, ERP, and GW declared competing interests based on affiliation with Google.
Patient consent for publication Not required.
Ethics approval This study was approved by the Riverside University Health System IRB Committee (No. 824116-9). All patient data were deidentified, and patient consent for this retrospective study was not required by the IRB.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The data are deidentified participant data, available from GB; visionforall2020@gmail.com.