title: Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access.
abstract: OBJECTIVE
  To estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy.
  
  
  METHODS
  Utilizing the computerized billing records database, we identified patients with International Classification of Diseases (ICD)-9 diagnoses of DM, but without any ocular diagnoses. The available medical records of patients in 2007-2008 were reviewed for demographic and ocular information, including visits through 2010 (n=200). Patients were considered guideline compliant if they returned at least every 15 months for screening. Participant street addresses were assigned latitude and longitude coordinates to assess their neighborhood socioeconomic status (using the 2000 US census data), distance to the screening facility, and public transportation access. Patients not compliant, based on the medical record review, were contacted by phone or mail and asked to complete a follow-up survey to determine if screening took place at other locations.
  
  
  RESULTS
  The overall screening compliance rate was 31%. Patient sociodemographic characteristics, insurance status, and neighborhood socioeconomic measures were not significantly associated with compliance. However, in separate multivariable logistic regression models, those living eight or more miles from the screening facility were significantly less likely to be compliant relative to those living within eight miles (OR=0.36 (95% CI 0.14 to 0.86)), while public transit access quality was positively associated with screening compliance (1.34 (1.07 to 1.68)).
  
  
  CONCLUSIONS
  Less than one-third of patients returned for diabetic retinopathy screening at least every 15 months, with transportation challenges associated with noncompliance. Our results suggest that reducing transportation barriers or utilizing community-based screening strategies may improve compliance.
authors.affiliation: Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
authors.affiliation: Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.affiliation: Division of Diabetes Translation , National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, USA.
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Potyra R
authors.initials: PR
authors.lastname: Rosa
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Schiffman
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Morante
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Aldahan
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Staropoli
authors.affiliation: Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Cristina A
authors.initials: CA
authors.lastname: Fernandez
authors.affiliation: Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.affiliation: Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
keywords: Retinopathy Diagnosis