Factors Associated with Non-compliance for Diabetic Retinopathy Follow-up in an Urban Safety-Net Hospital

ABSTRACT

Purpose: Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-aged adults, and compliance in ophthalmic follow-up appointments is critical to prevent vision loss. However, barriers to follow-up care have not been well studied, especially in socio-economically disadvantaged groups. We investigated the risk factors for non-compliance to DR follow-up appointments in a safety-net county hospital.

Methods: Two hundred and nine patients who were treated for DR at the Zuckerberg San Francisco General Hospital retina clinic between 1 July 2015 and 30 January 2016 were enrolled in the study. Multivariate logistic regression analysis of demographic and medical information was used to determine independent risk factors for non-compliance to DR follow-up appointments.

Results: The mean patient age was 58 years. Sixty-three percent (132/209) of patients were male; the mean haemoglobin A1c level was 8.5 (SD 0.14). Forty-six percent (97/209) of patients attended <80% of their DR follow-up appoinments. Independent risk factors for non-compliance after multivariate logistic regression analysis were diabetic foot involvement [OR: 2.40, 95% CI: (1.04–5.55)] and foot/kidney involvement [OR: 3.79 (1.35–10.5)], history of major depressive disorder (MDD) [OR: 2.11 (1.05–4.26), and having Medi-Cal [OR: 5.01 (2.00–12.5)] or SF Health insurance [OR: 6.79 (2.14–21.5)].

Conclusions and Relevance: In conclusion, this is the first study to identify diabetic end organ damage and MDD as independent risk factors for non-compliance in DR follow-up appointments. It is important that health care providers identify these patient subsets and increase efforts to more deliberately encourage follow-up in these high-risk patient groups for DR.

KEYWORDS:

• Risk factors
• non-compliance
• diabetic retinopathy
• follow-up

Acknowledgment

This research study was presented at the 2016 Association for Research in Vision and Ophthalmology conference in Seattle, WA, on 1 May 2016.

Declaration of interest

None

Additional information

Funding

None