Unintended consequences of delisting routine eye exams on retinopathy screening for people with diabetes in Ontario, Canada

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

“…Report Supplementary Material 2 [see Characteristics of the 65 included studies (phase 2 review)] shows the characteristics of the 65 included studies. Forty-one (63%) 147,148,150,151,153,156,[162][163][164][165][166]171,[175][176][177][178][179][180]182,[184][185][186][187]190,192,[194][195][196][197][198][199][201][202][203][204][205][206][207][208][209][210] used quantitative methods only (e.g. questionnaires, surveys), 18 (28%) 149,152,154,155,[157][158][159][160]...…”

“…The quality appraisals of the included studies (n = 53 24,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][163][164][165][166][167][168][169][170][172][173][174][175][177][178][179][180]182,184,185,187,[190][191][192]194,195,197,199,[201][202][203][204][205][206][207][208]…”

“…150,151 However, in some cases people with diabetes were not aware that they were exempted from payment and this lack of awareness or 'knowledge of benefits' resulted in lower attendance rates. 152,153 Self-employed people with diabetes had additional hidden financial costs as they lost income when they took time off work to attend their screening appointments. 154,155 Theme: scheduling appointment issues…”

Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists

“…Nonetheless, we utilized this as a baseline examination rate, since it was the best available data for PEI. We obtained the impact of publicly insured optometric services on the examination rate from a published Canadian study that had evaluated the effect of delisting routine eye examinations on retinopathy screening among patients with diabetes in Ontario [17]. The Ontario study reported that delisting routine eye examinations decreased the eye examination rate by 8.7% among patients 40 to 65 years of age who were living with diabetes, although this age group was not the intended delisting target.…”

Clinical Diabetes Research Using Data Mining: A Canadian Perspective

“…Because these data are often collected for healthcare administrative purposes, they are particularly suited for this type of research. For example, the impact of changes to healthcare programs or policies can be ascertained in "natural experiments" (26,27), and the quality of care delivered to patients by the healthcare system can be evaluated (28e30).…”