Clinical Ophthalmology (Aug 2020)
Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
Abstract
Jeremy J Peavey,1 Samantha L D’Amico,1 Brian Y Kim,1 Stephen T Higgins,2,3 David S Friedman,4 Christopher J Brady1,2 1Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA; 2Vermont Center for Behavior and Health, Larner College of Medicine, Burlington, VT, USA; 3Departments of Psychiatry and Psychological Science, Larner College of Medicine, University of Vermont, Burlington, VT, USA; 4Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USACorrespondence: Christopher J BradyDepartment of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT 05401, USATel +1 802 847 0400Email [email protected]: 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.Keywords: diabetes mellitus, socioeconomic disadvantage, rural medicine, follow-up attendance
