Barriers to compliance with screening guidelines for diabetic retinopathy.
OBJECTIVE
To identify barriers to compliance with guidelines for diabetic retinopathy screening.


METHODS
The population studied included 4410 adults, aged 31 to 64, enrolled in an Independent Practice Association (IPA) plan in Upstate New York, who were diagnosed with diabetes, and their Primary Care Physicians (408 PCPs). Claims data were used to calculate variables characterizing patients and their PCPs. Logistic regression models were estimated to identify factors associated with higher probability of screening.


RESULTS
34% of patients were screened in 1993. The probability of screening was significantly higher for older patients, for women, for patients who visit their PCPs more often and for those living in areas of higher average education and lower percentage of blacks. However, only 16% of diabetic patients received an annual screen in two consecutive years (1992 and 1993). The probability of consecutive annual screening was significantly associated only with gender and patient expenditures per month.


CONCLUSIONS
The very low rate of diabetic retinopathy screening has implications for quality of life of patients with diabetes, long term costs of caring for them and social costs due to lost productivity. Interventions to increase screening rates are needed and should target both patients and their Primary Care Physicians.
Mukamel
D B
DB
Department of Community & Preventive Medicine, University of Rochester Medical Center, N.Y. 14642, USA.
Bresnick
G H
GH
Wang
Q
Q
Dickey
C F
CF
D000328:Adult; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D010821:Physicians, Family / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards*; D011322:Primary Prevention / Q000592:standards; D011336:Probability; D015351:Vision Screening