Adherence to Ophthalmology Referral, Treatment and Follow-up: What Happens After Diabetic Retinopathy Screening in the Primary Care Setting? A Retrospective Record Review Study
Abstract
Purpose
Telemedicine-based diabetic retinopathy screening (DRS) in primary care has increased rates of retinal exams in patients with diabetes resulting in more detected cases of vision threatening diabetic retinopathy (VTDR). Blindness from diabetes, however, remains a major problem. The present study examines the extent to which patients with VTDR adhered to post-screening recommendations following DRS.
Methods
A retrospective record review was conducted in the primary care clinic of a large county hospital in the US. All patients with VTDR detected through telemedicine-based DRS over a 5-year period were included. Data points for patients included: interval for keeping initial ophthalmology appointment, starting recommended treatments (if any), and keeping follow-up appointments.
Results
Adequate records were available for 6046 patients of whom 408 (7%) were referred for VTDR to Ophthalmology. Few of the referred patients (5%) were seen by an Ophthalmologist within the recommended referral interval; only 14-16% were seen within twice the recommended interval, and 48-57% within one year of DRS. Of those seeing an Ophthalmologist, treatment was recommended in half of the cases and was initiated for the majority (94%) of those patients. Adherence to follow-up visits for those not recommended for treatment was considerably less. Primary care providers seemed generally unaware that many of their patients referred for VTDR were not adhering to the recommended follow-up.
Conclusion
Reducing impairment from diabetic retinopathy requires more than increasing the rates of screening in primary care clinics. Making sure that patients who screen positive for VTDR are seen by a specialist and get the treatment they need may require structural improvements to the referral and coordination process between primary and specialty care. Patient centered approaches to reducing barriers to specialty care and treatment should also be considered. Blindness prevention from VTDR starts with retinopathy screening, but must include educating patients, monitoring adherence and streamlining ophthalmic referral and disease management.
Telemedicine-based diabetic retinopathy screening (DRS) in primary care has increased rates of retinal exams in patients with diabetes resulting in more detected cases of vision threatening diabetic retinopathy (VTDR). Blindness from diabetes, however, remains a major problem. The present study examines the extent to which patients with VTDR adhered to post-screening recommendations following DRS.
Methods
A retrospective record review was conducted in the primary care clinic of a large county hospital in the US. All patients with VTDR detected through telemedicine-based DRS over a 5-year period were included. Data points for patients included: interval for keeping initial ophthalmology appointment, starting recommended treatments (if any), and keeping follow-up appointments.
Results
Adequate records were available for 6046 patients of whom 408 (7%) were referred for VTDR to Ophthalmology. Few of the referred patients (5%) were seen by an Ophthalmologist within the recommended referral interval; only 14-16% were seen within twice the recommended interval, and 48-57% within one year of DRS. Of those seeing an Ophthalmologist, treatment was recommended in half of the cases and was initiated for the majority (94%) of those patients. Adherence to follow-up visits for those not recommended for treatment was considerably less. Primary care providers seemed generally unaware that many of their patients referred for VTDR were not adhering to the recommended follow-up.
Conclusion
Reducing impairment from diabetic retinopathy requires more than increasing the rates of screening in primary care clinics. Making sure that patients who screen positive for VTDR are seen by a specialist and get the treatment they need may require structural improvements to the referral and coordination process between primary and specialty care. Patient centered approaches to reducing barriers to specialty care and treatment should also be considered. Blindness prevention from VTDR starts with retinopathy screening, but must include educating patients, monitoring adherence and streamlining ophthalmic referral and disease management.
Research Areas
