title: Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases.
abstract: OBJECTIVE
  To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM).
  
  
  METHODS
  Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS).
  
  
  METHODS
  The sample consisted of 2151 Medicare beneficiaries who responded to the HRS.
  
  
  METHODS
  Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination.
  
  
  METHODS
  The primary outcome measure was the number of 15-month periods with an eye examination.
  
  
  RESULTS
  One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations.
  
  
  CONCLUSIONS
  Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.
authors.affiliation: Department of Economics, Duke University, Durham, North Carolina. Electronic address: fsloan@duke.edu.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Sloan
authors.affiliation: Department of Economics, Duke University, Durham, North Carolina.
authors.forename: Arseniy P
authors.initials: AP
authors.lastname: Yashkin
authors.affiliation: Department of Economics, Duke University, Durham, North Carolina.
authors.forename: Yiqun
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease; D003920:Diabetes Mellitus; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000517:prevention & control*; D015438:Health Behavior; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States