TY - JOUR
T1 - Impact of socioeconomic disadvantage and diabetic retinopathy severity on poor ophthalmic follow-up in a rural vermont and new york population
AU - Peavey, Jeremy J.
AU - D’amico, Samantha L.
AU - Kim, Brian Y.
AU - Higgins, Stephen T.
AU - Friedman, David S.
AU - Brady, Christopher J.
N1 - Funding Information:
CJB was supported by the National Institute of General Medical Sciences of the National Institutes of Health under A ward Number P20GM103644. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. BYK and SD were supported in part by the Elliot W . Shipman Professorship Fund.
Funding Information:
The Jeffords Institute for Quality and Operational Effectiveness provided study design consultation and technical assistance with retrieval of data from the electronic health record. CJB was supported by the National Institute of GeneraMedical Sciences of the National Institutes of Health under Award Number P20GM103644. The content isolely the responsibility of the authors and does not necessarily represent the official views of the National Instituteof Health. BYK and SD were supported in part by thElliot W. Shipman Professorship Fund.
Publisher Copyright:
© 2020 Peavey et al.
PY - 2020
Y1 - 2020
N2 - Objective: To investigate the impact of socioeconomic disadvantage and diabetic retinopathy severity on follow-up for vision care among people with diabetes mellitus (DM) residing in rural Vermont and northern New York State. Methods: A retrospective chart review of people with DM who visited our academic eye clinic at least once between October 1, 2015, and March 31, 2016, was done. Of 1,466 unique patient visits, 500 were chosen for full chart review by simple random sampling. DM follow-up within 1 year was recommended for 331 adults. Data about prescribed and actual follow-up intervals were extracted. Regression models were used to identify factors associated with poor attendance at follow-up appointments. Results: Sixty-eight [20.5%] patients had poor follow-up, defined as no ophthalmology visit within double the prescribed interval. Of these, 57 were not seen in follow-up by the end of study observation. Poor follow-up was greatest among socioeconomically disadvantaged patients, as defined by Medicaid enrollment (odds ratio [OR], 1.95; 95% CI, 1.07–3.56) in comparison to non-disadvantaged patients. Follow-up was better among those with moderate or worse diabetic retinopathy (OR, 0.38 95% CI, 0.20–0.70), and those with macular edema (OR, 0.19; 95% CI, 0.057–0.62). Conclusion: Medicaid insurance and better diabetic retinopathy status were associated with worse follow-up among our predominantly rural population of patients. Patients who did not follow-up within double the recommended interval were unlikely to follow-up at all. Interventions are needed to target those at highest risk for poor follow-up.
AB - Objective: To investigate the impact of socioeconomic disadvantage and diabetic retinopathy severity on follow-up for vision care among people with diabetes mellitus (DM) residing in rural Vermont and northern New York State. Methods: A retrospective chart review of people with DM who visited our academic eye clinic at least once between October 1, 2015, and March 31, 2016, was done. Of 1,466 unique patient visits, 500 were chosen for full chart review by simple random sampling. DM follow-up within 1 year was recommended for 331 adults. Data about prescribed and actual follow-up intervals were extracted. Regression models were used to identify factors associated with poor attendance at follow-up appointments. Results: Sixty-eight [20.5%] patients had poor follow-up, defined as no ophthalmology visit within double the prescribed interval. Of these, 57 were not seen in follow-up by the end of study observation. Poor follow-up was greatest among socioeconomically disadvantaged patients, as defined by Medicaid enrollment (odds ratio [OR], 1.95; 95% CI, 1.07–3.56) in comparison to non-disadvantaged patients. Follow-up was better among those with moderate or worse diabetic retinopathy (OR, 0.38 95% CI, 0.20–0.70), and those with macular edema (OR, 0.19; 95% CI, 0.057–0.62). Conclusion: Medicaid insurance and better diabetic retinopathy status were associated with worse follow-up among our predominantly rural population of patients. Patients who did not follow-up within double the recommended interval were unlikely to follow-up at all. Interventions are needed to target those at highest risk for poor follow-up.
KW - Diabetes mellitus
KW - Follow-up attendance
KW - Rural medicine
KW - Socioeconomic disadvantage
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U2 - 10.2147/OPTH.S258270
DO - 10.2147/OPTH.S258270
M3 - Article
C2 - 32904606
AN - SCOPUS:85089698795
VL - 14
SP - 2397
EP - 2403
JO - Clinical Ophthalmology
JF - Clinical Ophthalmology
SN - 1177-5467
ER -