Allison J Chen1, Vicky Hwang2, Pui Yee Law2, Jay M Stewart2, Daniel L Chao1. 1. a Shiley Eye Institute, Department of Ophthalmology , University of California , San Diego , California , USA. 2. b Department of Ophthalmology , University of California , San Francisco , California , USA.
Abstract
PURPOSE: Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-aged adults, and compliance in ophthalmic follow-up appointments is critical to prevent vision loss. However, barriers to follow-up care have not been well studied, especially in socio-economically disadvantaged groups. We investigated the risk factors for non-compliance to DR follow-up appointments in a safety-net county hospital. METHODS: Two hundred and nine patients who were treated for DR at the Zuckerberg San Francisco General Hospital retina clinic between 1 July 2015 and 30 January 2016 were enrolled in the study. Multivariate logistic regression analysis of demographic and medical information was used to determine independent risk factors for non-compliance to DR follow-up appointments. RESULTS: The mean patient age was 58 years. Sixty-three percent (132/209) of patients were male; the mean haemoglobin A1c level was 8.5 (SD 0.14). Forty-six percent (97/209) of patients attended <80% of their DR follow-up appoinments. Independent risk factors for non-compliance after multivariate logistic regression analysis were diabetic foot involvement [OR: 2.40, 95% CI: (1.04-5.55)] and foot/kidney involvement [OR: 3.79 (1.35-10.5)], history of major depressive disorder (MDD) [OR: 2.11 (1.05-4.26), and having Medi-Cal [OR: 5.01 (2.00-12.5)] or SF Health insurance [OR: 6.79 (2.14-21.5)]. CONCLUSIONS AND RELEVANCE: In conclusion, this is the first study to identify diabetic end organ damage and MDD as independent risk factors for non-compliance in DR follow-up appointments. It is important that health care providers identify these patient subsets and increase efforts to more deliberately encourage follow-up in these high-risk patient groups for DR.
PURPOSE: Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-aged adults, and compliance in ophthalmic follow-up appointments is critical to prevent vision loss. However, barriers to follow-up care have not been well studied, especially in socio-economically disadvantaged groups. We investigated the risk factors for non-compliance to DR follow-up appointments in a safety-net county hospital. METHODS: Two hundred and nine patients who were treated for DR at the Zuckerberg San Francisco General Hospital retina clinic between 1 July 2015 and 30 January 2016 were enrolled in the study. Multivariate logistic regression analysis of demographic and medical information was used to determine independent risk factors for non-compliance to DR follow-up appointments. RESULTS: The mean patient age was 58 years. Sixty-three percent (132/209) of patients were male; the mean haemoglobin A1c level was 8.5 (SD 0.14). Forty-six percent (97/209) of patients attended <80% of their DR follow-up appoinments. Independent risk factors for non-compliance after multivariate logistic regression analysis were diabetic foot involvement [OR: 2.40, 95% CI: (1.04-5.55)] and foot/kidney involvement [OR: 3.79 (1.35-10.5)], history of major depressive disorder (MDD) [OR: 2.11 (1.05-4.26), and having Medi-Cal [OR: 5.01 (2.00-12.5)] or SF Health insurance [OR: 6.79 (2.14-21.5)]. CONCLUSIONS AND RELEVANCE: In conclusion, this is the first study to identify diabetic end organ damage and MDD as independent risk factors for non-compliance in DR follow-up appointments. It is important that health care providers identify these patient subsets and increase efforts to more deliberately encourage follow-up in these high-risk patient groups for DR.
Authors: David S Boyer; Joerg F Rippmann; Michael S Ehrlich; Remko A Bakker; Victor Chong; Quan Dong Nguyen Journal: Int J Retina Vitreous Date: 2021-04-12
Authors: Arthur R Brant; Suzann Pershing; Olivia Hess; David Rooney; Jeffrey Goldberg; Geoffrey Tabin; Sophia Y Wang Journal: Clin Ophthalmol Date: 2021-12-08