Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population

Jeremy J Peavey,1 Samantha L D’Amico,1 Brian Y Kim,1 Stephen T Higgins,2,3 David S Friedman,4 Christopher J Brady1,2 1Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA; 2Vermont Center for Behavior and...

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Autores principales:	Peavey JJ, D'Amico SL, Kim BY, Higgins ST, Friedman DS, Brady CJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	diabetes mellitus socioeconomic disadvantage rural medicine follow-up attendance Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/cf56b091518846f59d4a6c360b05d4ff
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spelling	oai:doaj.org-article:cf56b091518846f59d4a6c360b05d4ff2021-12-02T13:00:31ZImpact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population1177-5483https://doaj.org/article/cf56b091518846f59d4a6c360b05d4ff2020-08-01T00:00:00Zhttps://www.dovepress.com/impact-of-socioeconomic-disadvantage-and-diabetic-retinopathy-severity-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Jeremy J Peavey,1 Samantha L D’Amico,1 Brian Y Kim,1 Stephen T Higgins,2,3 David S Friedman,4 Christopher J Brady1,2 1Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA; 2Vermont Center for Behavior and Health, Larner College of Medicine, Burlington, VT, USA; 3Departments of Psychiatry and Psychological Science, Larner College of Medicine, University of Vermont, Burlington, VT, USA; 4Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USACorrespondence: Christopher J BradyDepartment of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT 05401, USATel +1 802 847 0400Email cbrady3@uvm.eduObjective: To investigate the impact of socioeconomic disadvantage and diabetic retinopathy severity on follow-up for vision care among people with diabetes mellitus (DM) residing in rural Vermont and northern New York State.Methods: A retrospective chart review of people with DM who visited our academic eye clinic at least once between October 1, 2015, and March 31, 2016, was done. Of 1,466 unique patient visits, 500 were chosen for full chart review by simple random sampling. DM follow-up within 1 year was recommended for 331 adults. Data about prescribed and actual follow-up intervals were extracted. Regression models were used to identify factors associated with poor attendance at follow-up appointments.Results: Sixty-eight [20.5%] patients had poor follow-up, defined as no ophthalmology visit within double the prescribed interval. Of these, 57 were not seen in follow-up by the end of study observation. Poor follow-up was greatest among socioeconomically disadvantaged patients, as defined by Medicaid enrollment (odds ratio [OR], 1.95; 95% CI, 1.07– 3.56) in comparison to non-disadvantaged patients. Follow-up was better among those with moderate or worse diabetic retinopathy (OR, 0.38 95% CI, 0.20– 0.70), and those with macular edema (OR, 0.19; 95% CI, 0.057– 0.62).Conclusion: Medicaid insurance and better diabetic retinopathy status were associated with worse follow-up among our predominantly rural population of patients. Patients who did not follow-up within double the recommended interval were unlikely to follow-up at all. Interventions are needed to target those at highest risk for poor follow-up.Keywords: diabetes mellitus, socioeconomic disadvantage, rural medicine, follow-up attendancePeavey JJD'Amico SLKim BYHiggins STFriedman DSBrady CJDove Medical Pressarticlediabetes mellitussocioeconomic disadvantagerural medicinefollow-up attendanceOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 2397-2403 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus socioeconomic disadvantage rural medicine follow-up attendance Ophthalmology RE1-994
spellingShingle	diabetes mellitus socioeconomic disadvantage rural medicine follow-up attendance Ophthalmology RE1-994 Peavey JJ D'Amico SL Kim BY Higgins ST Friedman DS Brady CJ Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
description	Jeremy J Peavey,1 Samantha L D’Amico,1 Brian Y Kim,1 Stephen T Higgins,2,3 David S Friedman,4 Christopher J Brady1,2 1Department of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT, USA; 2Vermont Center for Behavior and Health, Larner College of Medicine, Burlington, VT, USA; 3Departments of Psychiatry and Psychological Science, Larner College of Medicine, University of Vermont, Burlington, VT, USA; 4Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USACorrespondence: Christopher J BradyDepartment of Surgery, Division of Ophthalmology, University of Vermont Medical Center and Larner College of Medicine, Burlington, VT 05401, USATel +1 802 847 0400Email cbrady3@uvm.eduObjective: To investigate the impact of socioeconomic disadvantage and diabetic retinopathy severity on follow-up for vision care among people with diabetes mellitus (DM) residing in rural Vermont and northern New York State.Methods: A retrospective chart review of people with DM who visited our academic eye clinic at least once between October 1, 2015, and March 31, 2016, was done. Of 1,466 unique patient visits, 500 were chosen for full chart review by simple random sampling. DM follow-up within 1 year was recommended for 331 adults. Data about prescribed and actual follow-up intervals were extracted. Regression models were used to identify factors associated with poor attendance at follow-up appointments.Results: Sixty-eight [20.5%] patients had poor follow-up, defined as no ophthalmology visit within double the prescribed interval. Of these, 57 were not seen in follow-up by the end of study observation. Poor follow-up was greatest among socioeconomically disadvantaged patients, as defined by Medicaid enrollment (odds ratio [OR], 1.95; 95% CI, 1.07– 3.56) in comparison to non-disadvantaged patients. Follow-up was better among those with moderate or worse diabetic retinopathy (OR, 0.38 95% CI, 0.20– 0.70), and those with macular edema (OR, 0.19; 95% CI, 0.057– 0.62).Conclusion: Medicaid insurance and better diabetic retinopathy status were associated with worse follow-up among our predominantly rural population of patients. Patients who did not follow-up within double the recommended interval were unlikely to follow-up at all. Interventions are needed to target those at highest risk for poor follow-up.Keywords: diabetes mellitus, socioeconomic disadvantage, rural medicine, follow-up attendance
format	article
author	Peavey JJ D'Amico SL Kim BY Higgins ST Friedman DS Brady CJ
author_facet	Peavey JJ D'Amico SL Kim BY Higgins ST Friedman DS Brady CJ
author_sort	Peavey JJ
title	Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
title_short	Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
title_full	Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
title_fullStr	Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
title_full_unstemmed	Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population
title_sort	impact of socioeconomic disadvantage and diabetic retinopathy severity on poor ophthalmic follow-up in a rural vermont and new york population
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/cf56b091518846f59d4a6c360b05d4ff
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Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population

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