Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting

Autor: Pablo Cuadros, George H. Bresnick, Luohua Jiang, Jorge Cuadros, Mahbuba Khan, Sybille Fleischmann, Andrea Limon, Jenny Chang, Elin Rønby Pedersen, Gregory J. Wolff
Rok vydání: 2020
Předmět:
Research design
Telemedicine
medicine.medical_specialty
Referral
Endocrinology
Diabetes and Metabolism
Clinical Sciences
Bioengineering
Primary care
Clinical Care/Education/Nutrition
Eye
compliance
Diseases of the endocrine glands. Clinical endocrinology
03 medical and health sciences
primary care
0302 clinical medicine
Clinical Research
Diabetes mellitus
Ophthalmology
medicine
Diabetes Mellitus
Humans
030212 general & internal medicine
adherence
Referral and Consultation
Eye Disease and Disorders of Vision
Metabolic and endocrine
Retrospective Studies
Diabetic Retinopathy
Primary Health Care
business.industry
Medical record
Prevention
Diabetes
retinopathy screening
Diabetic retinopathy
Health Services
RC648-665
medicine.disease
compliance/adherence
ophthalmology
030221 ophthalmology & optometry
business
Retinopathy
Follow-Up Studies
Zdroj: BMJ open diabetes research & care, vol 8, iss 1
BMJ Open Diabetes Research & Care, Vol 8, Iss 1 (2020)
BMJ Open Diabetes Research & Care
Popis: IntroductionTelemedicine-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/methodsA 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.ResultsAdequate 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.ConclusionsReducing 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.
Databáze: OpenAIRE
Externí odkaz: