资源有限的学生运营免费诊所中未参保拉丁裔患者糖尿病视网膜病变筛查的评估与优化
Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.
作者信息
Bu Jennifer J, Delavar Arash, Dayao John Kevin, Lieu Alexander, Chuter Benton G, Chen Kevin, Nishihara Taiki, Meller Leo, Camp Andrew S, Lee Jeffrey E, Baxter Sally L
机构信息
Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA.
出版信息
J Stud Run Clin. 2024 Jan 18;10(1). doi: 10.59586/jsrc.v10i1.407.
BACKGROUND
Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients.
METHODS
Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation.
RESULTS
Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR.
CONCLUSION
The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.
背景
糖尿病视网膜病变（DR）是一种威胁视力的疾病，会导致视网膜进行性损伤。学生运营的免费诊所为高危人群提供糖尿病视网膜病变筛查提供了宝贵机会。我们对加利福尼亚大学圣地亚哥分校学生运营的眼科免费诊所的患者群体进行了特征分析，评估了其筛查效果，并进行了需求评估，该诊所主要为未参保的拉丁裔患者提供医疗服务。
方法
对自2019年以来在该免费诊所就诊且被诊断为II型糖尿病的所有患者进行回顾性病历审查。记录了2015年以来所有与糖尿病视网膜病变相关的筛查或就诊日期及结果、人口统计学信息以及糖化血红蛋白（A1c）和胰岛素依赖等糖尿病视网膜病变风险因素。使用多元逻辑回归、均值相等性t检验和皮尔逊相关性分析每位患者糖尿病视网膜病变的预测因素及糖尿病视网膜病变筛查频率。
结果
在该免费诊所接受治疗的179名未参保糖尿病患者中，71%为女性，平均年龄为59岁。83%患有高血压，93%患有高脂血症，79%患有代谢综合征。糖尿病患者中非增殖性糖尿病视网膜病变的患病率为34%，增殖性糖尿病视网膜病变的患病率为15%。近年来，该免费诊所的接诊能力稳定在每年接受糖尿病视网膜病变筛查或就诊患者的近50%，尽管两次就诊之间的平均等待时间超过2年。失约率较高的患者接受糖尿病视网膜病变筛查的频率较低。慢性肾脏病和血糖控制不佳是糖尿病视网膜病变最强的预测因素。
结论
学生运营的免费眼科诊所为糖尿病视网膜病变患者提供筛查和后续护理方面取得了成效。制定一个方案来确定哪些患者糖尿病视网膜病变风险最高且应更紧急就诊、解决失约问题以及实施远程视网膜项目是在资源有限的情况下提高针对弱势群体诊所效率的潜在途径。
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