Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami, Florida , USA.
Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.
BMJ Open Diabetes Res Care. 2014 Aug 23;2(1):e000031. doi: 10.1136/bmjdrc-2014-000031. eCollection 2014.
To estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy.
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.
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)).
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.
评估患有糖尿病（DM）但无糖尿病视网膜病变的患者进行眼部扩张检查指南的遵守情况及其相关因素。
利用计算机化的计费记录数据库，我们确定了患有国际疾病分类（ICD）-9 诊断为 DM 但无任何眼部诊断的患者。回顾了 2007-2008 年患者的现有病历，以获取人口统计学和眼部信息，包括 2010 年的就诊情况（n=200）。如果患者至少每 15 个月返回一次进行筛查，则认为他们符合指南要求。使用 2000 年美国人口普查数据为患者的街道地址分配纬度和经度坐标，以评估其邻里社会经济状况、到筛查机构的距离和公共交通的可达性。根据病历审查，对不符合规定的患者通过电话或邮件联系，并要求他们完成随访调查，以确定是否在其他地方进行了筛查。
总体筛查合规率为 31%。患者的社会人口统计学特征、保险状况和邻里社会经济措施与合规性无显著相关性。然而，在单独的多变量逻辑回归模型中，与居住在 8 英里以内的患者相比，居住在 8 英里以外的患者明显不太可能遵守规定（OR=0.36（95%CI 0.14 至 0.86）），而公共交通质量与筛查合规性呈正相关（1.34（1.07 至 1.68））。
不到三分之一的患者每 15 个月返回一次进行糖尿病视网膜病变筛查，交通挑战与不遵守规定有关。我们的研究结果表明，减少交通障碍或利用社区为基础的筛查策略可能会提高合规性。
