Factors Associated with Follow-Up Examination Following Positive Teleretinal Screening for Diabetic Retinopathy in an Urban Healthcare System
Background: Diabetic retinopathy (DR) is currently one of the leading causes of new blindness in the United States. Teleretinal imaging (TRI) may be used effectively as a screening tool to identify patients with DR before visual symptoms occur but requires that patients follow up with an eye care provider if pathologic changes are found. The Harris Health System (HHS) in Houston, TX, has a large teleretinal imaging program to screen for DR. ^ Study Question: What patient-related factors predict adherence to follow-up recommendations in patients with a positive TRI scan who have not recently been to an HHS eye clinic? ^ Study Design: Case-Control Study ^ Methods: All patients in the HHS who received a TRI screening examination and were referred for in-clinic examination from July 2014 to July 2016 were included in the study. Variables collected included patient demographics as well as hemoglobin A1C (HbA1C), insulin use status, and clinic location of TRI scan administration. Multiple logistic regression was used to determine factors associated with nonadherence to follow up. ^ Results: There were 1,824 patients included in the study. The overall follow up rate was 54.4 percent. Compared to patients with HbA1C less than 7.0% (follow-up rate 47.4%), patients with HbA1C 7.0-9.0% (follow up rate 55.8%) and HbA1C greater than 9.0% (follow-up rate 56.0%) were more likely to follow up (OR 1.36 and 1.83, respectively; p<0.05 for both). None of the other variables were associated with follow-up. ^ Discussion/Conclusion: Patients with moderately or poorly controlled blood glucose levels are more likely to follow up after an abnormal TRI screening examination. This may be due to increased visual symptoms in the moderate to poorly controlled diabetics or differing patient beliefs and knowledge about DR and follow-up between these groups. More research is needed to better understand why these differences exist and what can be done to increase adherence rate, especially in those with well-controlled diabetes.^
Chamberlain, Paul D, "Factors Associated with Follow-Up Examination Following Positive Teleretinal Screening for Diabetic Retinopathy in an Urban Healthcare System" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10786152.