Jani Pooja D, Forbes Lauren, McDaniel Philip, Viera Anthony, Garg Seema
Department of Ophthalmology, University of North Carolina at Chapel Hill2Department of Family Medicine, University of North Carolina at Chapel Hill.
Department of Ophthalmology, University of North Carolina at Chapel Hill.
JAMA Ophthalmol. 2017 Jul 1;135(7):715-721. doi: 10.1001/jamaophthalmol.2017.1153.
Minimal information exists on the use of geographic information systems mapping for visualizing access barriers to eye care for patients with diabetes.
To use geographic information systems mapping techniques to visualize (1) the locations of patients participating in the North Carolina Diabetic Retinopathy Telemedicine Network, (2) the locations of primary care clinicians and ophthalmologists across the state, and (3) the travel times associated with traveling to the 5 primary care clinics in our study.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted from January 6, 2014, to November 1, 2015, at 5 Area Health Education Center primary care clinics that serve rural and underserved populations in North Carolina. In total, 1787 patients with diabetes received retinal screening photographs with remote expert interpretation to determine the presence and severity of diabetic retinopathy. Participants included patients 18 years or older with type 1 or type 2 diabetes who presented to these 5 clinics for their routine diabetes care.
Development of qualitative maps illustrating the density of patients with diabetes and their distribution around the 5 North Carolina Diabetic Retinopathy Telemedicine Network sites by zip code and the density of ophthalmologists and primary care clinicians by zip code relative to US Census Urban Areas. A travel time map was also created using road network analysis to determine all areas that can be reached by car in a user-specified amount of time.
Mean (SD) age of patients was 55.4 (12.7) years. Women made up 62.7% of the study population. The study included more African American patients (55.4%) compared with white (35.5%) and Hispanic (5.8%) patients. The mean (SD) hemoglobin A1c level was 7.8% (2.4%) (to convert to proportion of total hemoglobin, multiply by 0.01), and the mean (SD) duration of diabetes was 9.2 (8.2) years. Whereas the clinics located in Greensboro, Asheville, and Fayetteville screened patients from more immediate surrounding areas, the Greenville site had the widest distribution of zip codes, suggesting that patients travel from greater distances to reach this facility. Primary care clinicians were spread somewhat uniformly across the state, whereas ophthalmologists were concentrated around urban centers. Also, the number and type of surface roads surrounding the clinics determined the distance and time patients must travel to receive care.
Geographic information systems mapping is a useful technique for visualizing geographic access barriers to eye care for patients with diabetes and may help to identify underserved areas that would benefit from the expansion of retinal screening programs via telemedicine.
关于使用地理信息系统绘图来直观呈现糖尿病患者获得眼科护理的障碍的信息极少。
运用地理信息系统绘图技术来直观呈现：（1）参与北卡罗来纳糖尿病视网膜病变远程医疗网络的患者的位置；（2）该州初级保健临床医生和眼科医生的位置；（3）前往我们研究中的5家初级保健诊所的出行时间。
设计、地点和参与者：于2014年1月6日至2015年11月1日在北卡罗来纳州5家为农村及服务不足人群提供服务的地区健康教育中心初级保健诊所进行的横断面研究。共有1787名糖尿病患者接受了视网膜筛查照片，并由远程专家进行解读以确定糖尿病视网膜病变的存在及严重程度。参与者包括18岁及以上的1型或2型糖尿病患者，他们前往这5家诊所接受常规糖尿病护理。
绘制定性地图，按邮政编码说明糖尿病患者的密度及其在北卡罗来纳糖尿病视网膜病变远程医疗网络5个站点周围的分布情况，以及按邮政编码说明相对于美国人口普查城市区域的眼科医生和初级保健临床医生的密度。还使用道路网络分析创建了一张出行时间地图，以确定在用户指定时间内驾车可到达的所有区域。
患者的平均（标准差）年龄为55.4（12.7）岁。女性占研究人群的62.7%。与白人（35.5%）和西班牙裔（5.8%）患者相比，该研究纳入了更多非裔美国患者（55.4%）。血红蛋白A1c的平均（标准差）水平为7.8%（2.4%）（若要转换为总血红蛋白的比例，乘以0.01），糖尿病的平均（标准差）病程为9.2（8.2）年。格林斯伯勒、阿什维尔和费耶特维尔的诊所筛查的患者来自更直接的周边地区，而格林维尔站点的邮政编码分布最广，这表明患者从更远的距离前来就诊。初级保健临床医生在该州分布较为均匀，而眼科医生集中在城市中心周围。此外，诊所周围地面道路的数量和类型决定了患者接受护理必须出行的距离和时间。
地理信息系统绘图是一种有用的技术，可直观呈现糖尿病患者获得眼科护理的地理障碍，有助于识别那些可通过远程医疗扩大视网膜筛查项目而受益的服务不足地区。
