Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

Benoit, Stephen R.; Swenor, Bonnielin K.; Geiss, Linda S.; Gregg, Edward W.; Saaddine, Jinan B.

doi:10.2337/dc18-0828

Cited by 74 publications

(51 citation statements)

References 22 publications

(14 reference statements)

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“…Consistent with previous studies [9,13,14], older age was associated with eye care utilization among people with diabetes. Specifically, people aged 55 years and above were more likely to utilize eye care services.…”

Section: Discussionsupporting

confidence: 91%

“…The rates of eye care utilization among people with diabetes have been reported in different population-based studies [ 9 – 12 ]. For example, in the United States, both Benoit et al [ 9 ] and MacLennan et al [ 13 ] reported that nearly half of all patients with diabetes had not had an eye exam in over 5 years. In a hospital-based study in India, Sreenivas et al [ 12 ] reported that about a third of diabetic patients sampled had accessed eye care services in the last 1 year.…”

Section: Discussionmentioning

confidence: 99%

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Eye care utilization among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1): a cross-sectional study

et al. 2020

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Objective: Diabetes is a chronic disease of uncontrolled blood sugar levels. People with diabetes are at an increased risk of developing visual impairment and other diabetes-related visual complications. The study aims to determine the eyecare utilization pattern and its associated determinants among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1). Results: The mean age of participants was 56.2 years and 66.6% were females. The prevalence of eyecare utilization among participants was 49.0% and this differed significantly by age groups (p = 0.024) and the number of years since diabetes diagnosis (p < 0.001). After statistical adjustments, older age (55-64 years OR = 4.18, p = 0.003 and ≥ 65 years OR = 4.78, p = 0.002), having health insurance (OR = 6.32, p = 0.002), and having had diabetes for 6-10 years (OR = 4.23, p = 0.005) were significantly associated with eye care utilization. About half of people diagnosed with diabetes in South Africa have had an eye examination since diabetes diagnosis, which is disturbingly low given the impact of diabetes complications on eye health. Government policies must be directed at ensuring access to affordable health insurance and eye health education on diabetes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Eye care utilization among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1): a cross-sectional study

et al. 2020

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“…Although DRS is found to be effective, uptake is often suboptimal [13][14][15][16][17][18]. In Ireland, RetinaScreen provides free, annual retinal screening (and if necessary, treatment) to anyone aged 12 years or older with diagnosed diabetes.…”

Section: Introductionmentioning

confidence: 99%

Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening

et al. 2020

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Background: 'Implementation interventions' refer to methods used to enhance the adoption and implementation of clinical interventions such as diabetic retinopathy screening (DRS). DRS is effective, yet uptake is often suboptimal. Despite most routine management taking place in primary care and the central role of health care professionals (HCP) in referring to DRS, few interventions have been developed for primary care. We aimed to develop a multifaceted intervention targeting both professionals and patients to improve DRS uptake as an example of a systematic development process combining theory, stakeholder involvement, and evidence. Methods: First, we identified target behaviours through an audit in primary care of screening attendance. Second, we interviewed patients (n = 47) and HCP (n = 30), to identify determinants of uptake using the Theoretical Domains Framework, mapping these to behaviour change techniques (BCTs) to develop intervention content. Thirdly, we conducted semi-structured consensus groups with stakeholders, specifically users of the intervention, i.e. patients (n = 15) and HCPs (n = 16), regarding the feasibility, acceptability, and local relevance of selected BCTs and potential delivery modes. We consulted representatives from the national DRS programme to check intervention 'fit' with existing processes. We applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) to select the final intervention components, drawing on findings from the previous steps, and a rapid evidence review of operationalised BCT effectiveness. Results: We identified potentially modifiable target behaviours at the patient (consent, attendance) and professional (registration) level. Patient barriers to consent/attendance included confusion between screening and routine eye checks, and fear of a negative result. Enablers included a recommendation from friends/family or professionals and recognising screening importance. Professional barriers to registration included the time to register patients and a lack of readily available information on uptake in their local area/practice. Most operationalised BCTs were acceptable to patients and HCPs while the response to feasibility varied. After considering APEASE, the core intervention, incorporating a range of BCTs, involved audit/feedback, electronic prompts targeting professionals, HCP-endorsed reminders (face-to-face, by phone and letter), and an information leaflet for patients.

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“…By contrast, a study from Japan using claims data found an annual utilization rate of 95.8% 38. For eye examination, studies in the USA reported utilization rates of 15.3% (using claims data),39 70% (using telephone survey data),40 and 75% (data from rural Latinos) 41. A Japanese study reported a utilization rate of 35.6%,38 and the rate in the Italian study was even lower (15.6%) 37.…”

Section: Discussionmentioning

confidence: 93%

Exploring geographic variation of and influencing factors for utilization of four diabetes management measures in Swiss population using claims data

Wei

Gruebner

Wyl

et al. 2020

BMJ Open Diab Res Care

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IntroductionFour strongly recommended diabetes management measures are biannual glycated hemoglobin (HbA1c) testing, annual eye examination, kidney function examination, and low-density lipoprotein (LDL) testing in patients below 75 years. We aimed to describe regional variation in the utilization of the four measures across small regions in Switzerland and to explore potential influencing factors.Research design and methodsWe conducted a cross-sectional study of adult patients with drug-treated diabetes in 2014 using claims data. Four binary outcomes represented adherence to the recommendations. Possible influencing factors included sociodemographics, health insurance preferences, and clinical characteristics. We performed multilevel modeling with Medstat regions as the higher level. We calculated the median odds ratio (MOR) and checked spatial autocorrelation in region level residuals using Moran’s I statistic. When significant, we further conducted spatial multilevel modeling.ResultsOf 49 198 patients with diabetes (33 957 below 75 years), 69.6% had biannual HbA1c testing, 44.3% each had annual eye examination and kidney function examination, and 55.5% of the patients below 75 years had annual LDL testing. The effects of health insurance preferences were substantial and consistent. Having any supplementary insurance (ORs across measures were between 1.08 and 1.28), having supplementary hospital care insurance (1.08–1.30), having chosen a lower deductible level (eg, SFr2500 compared with SFr300: 0.57–0.69), and having chosen a managed care model (1.04–1.17) were positively associated with recommendations adherence. The MORs (1.27–1.33) showed only moderate unexplained variation, and we observed inconsistent spatial patterns of unexplained variation across the four measures.ConclusionOur findings indicate that the uptake of strongly recommended measures in diabetes management could possibly be optimized by providing further incentives to patients and care providers through insurance scheme design. The absence of marked regional variation implies limited potential for improvement by targeted regional intervention, while provider-specific promotion may be more impactful.

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Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014

Cited by 74 publications

References 22 publications

Eye care utilization among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1): a cross-sectional study

Eye care utilization among diabetics in the South African National Health and Nutrition Examination Survey (SANHANES-1): a cross-sectional study

Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening

Exploring geographic variation of and influencing factors for utilization of four diabetes management measures in Swiss population using claims data

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