Patients' Adherence to Recommended Follow-up Eye Care After Diabetic Retinopathy Screening in a Publicly Funded County Clinic and Factors Associated With Follow-up Eye Care Use
Patients' Adherence to Recommended Follow-up Eye Care After Diabetic Retinopathy Screening in a Publicly Funded County Clinic and Factors Associated With Follow-up Eye Care Use
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DOI：
10.1001/jamaophthalmol.2016.3081
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发表时间：
2016-11-01
影响因子：
8.1
通讯作者：
Owsley, Cynthia
中科院分区：
文献类型：
--
作者：
Keenum, Zachary;McGwin, Gerald, Jr.;Owsley, Cynthia
重要性糖尿病视网膜病变(DR)筛查计划的公共卫生成功取决于患者遵守筛查计划建议的后续眼部护理时间表。非裔美国人是糖尿病视网膜病变风险最高的人群之一，也是眼部护理使用率最低的人群之一。目的评估在安全网医疗机构实施的糖尿病视网膜病变筛查计划中推荐的后续眼部护理的依从率，并检查与后续眼睛护理使用相关的因素。设计、设置和参与者对1型或2型糖尿病患者进行前瞻性随访研究。背景是阿拉巴马州一家公共资助的医疗系统的内科诊所，为基本上没有保险的人群和非裔美国人提供服务，该诊所实施了一项DR筛查计划，使用非散瞳摄像头进行眼部成像，并使用远程阅读中心进行图像评估。2012年1月26日至7月24日期间预约医生的患者，如果他们被诊断为1型或2型糖尿病，并且年龄在19岁或以上，就有资格进行筛查。数据来自县卫生系统的行政数据库，从2012年1月26日(第一个登记者的日期)到2015年5月1日，以确定参与者在筛查后在眼科诊所的眼睛护理使用情况。主要结果和措施遵守行政记录确定的设施眼科服务中建议的眼睛预约间隔，以及与坚持相关的因素。结果完成了949名成年糖尿病患者的糖尿病视网膜病变筛查，其中84.5%(802/949)是非裔美国人，64.5%(612/949)是女性，71.7%(680/949)没有医疗保险。参与者的年龄从21岁到95岁不等，他们的平均年龄(SD)为53.9(10.4)岁。糖尿病诊断的平均年龄(SD)为44.3(12.5)岁，糖尿病病程平均为9.6(9.4)年。在间隔推荐类型中，29.9%(949人中的284人)坚持在推荐的时间范围内获得全面的后续眼科护理。在参与者的筛查日期两年后，50.9%(949人中的483人)没有接受过眼部护理的记录。坚持间隔预约的相关因素是高龄(优势比，1.02；95%CI，1.01-1.04)和知道自己的糖化血红蛋白水平(优势比，2.00；95%CI，1.34-2.97)。同意协助进行后续眼科护理预约与不遵守有关(优势比，0.67；95%可信区间，0.45-0.99)。结论和相关性：在一家主要服务于非裔美国人的公立诊所进行DR筛查后，只有三分之一的参与者坚持后续眼科护理预约的间隔建议，尽管成本和可及性作为护理障碍被降至最低。我们的发现表明，如果不将眼睛健康教育倡议成功地纳入，DR筛查计划就不太可能实现其公共卫生目标，从而成功地促进坚持推荐的全面眼睛护理以防止视力丧失。
IMPORTANCE The public health success of diabetic retinopathy (DR) screening programs depends on patients' adherence to the timetable of follow-up eye care recommended by the screening program. African Americans are among those at highest risk for DR and have one of the lowest rates of eye care use.OBJECTIVES To assess the rate of adhering to recommended follow-up eye care in a DR screening program administered in a safety-net health care facility and to examine factors associated with follow-up eye care use.DESIGN, SETTING, AND PARTICIPANTS Prospective follow-up study of persons with type 1 or type 2 diabetes. The setting was an internal medicine clinic of a publicly funded health system in Alabama, serving a population largely uninsured and African American, that had implemented a DR screening program using a nonmydriatic camera for ocular imaging and remote reading centers for evaluation of images. Patients with physician appointments between January 26 and July 24, 2012, were eligible for screening if they had a diagnosis of type 1 or type 2 diabetes and were 19 years or older. Data from the county health system's administrative database were obtained from January 26, 2012 (date of first enrollee), through May 1, 2015, to establish participants' eye care use in the ophthalmology clinic after screening.MAIN OUTCOMES AND MEASURES Adherence to the recommended interval of follow-up eye appointments in the facility's ophthalmology service as determined by administrative records, as well as factors associated with adherence.RESULTS Diabetic retinopathy screening was completed in 949 adults with diabetes, of whom 84.5%(802 of 949) were African American, 64.5%(612 of 949) were women, and 71.7%(680 of 949) lacked health insurance. Participants ranged in age from 21 to 95 years, and their mean (SD) age was 53.9 (10.4) years. The mean (SD) age at diabetes diagnosis was 44.3 (12.5) years, and the mean (SD) duration of diabetes was 9.6 (9.4) years. Across interval recommendation types, 29.9%(284 of 949) adhered to obtaining comprehensive follow-up eye care within the recommended time frame. Two years after a participant's screening date, 50.9%(483 of 949) had no record of having received eye care. Factors associated with adhering to interval appointments were having an advanced age (odds ratio, 1.02; 95% CI, 1.01-1.04) and knowing one's glycated hemoglobin level (odds ratio, 2.00; 95% CI, 1.34-2.97). Agreeing to assistance in making a follow-up eye care appointment was associated with nonadherence (odds ratio, 0.67; 95% CI, 0.45-0.99).CONCLUSIONS AND RELEVANCE After a DR screening program in a public clinic largely serving an African American population, only one-third of participants adhered to interval recommendations for follow-up eye appointments, even though cost and accessibility were minimized as barriers to care. Our findings suggest that DR screening programs are not likely to meet their public health goals without incorporation of eye health education initiatives successfully promoting adherence to recommended comprehensive eye care for preventing vision loss.