Primary Care Settings Offer Opportunity for Wider Screening for Diabetic Retinopathy

MedicalResearch.com Interview with:

Diane M. Gibson, Ph.D. Executive Director – New York Federal Statistical Research Data Center, Baruch RDC Associate Professor – Marxe School of Public and International Affairs, Baruch College - CUNY

Dr. Gibson

Diane M. Gibson, Ph.D.
Executive Director – New York Federal Statistical Research Data Center, Baruch RDC
Associate Professor – Marxe School of Public and International Affairs, Baruch College – CUNY

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prior studies have found that screening for diabetic retinopathy in primary care settings using telemedicine increased screening rates among individuals with diabetes and among subgroups of individuals with diabetes who are at high risk of missing recommended eye exams.  In a previous paper I looked at how often U.S. adults with diabetes visited primary care and eye care providers for recommended diabetes preventive care services using a sample from the 2007-2013 Medical Expenditure Panel Survey.  I found that while visits to eye care providers were often skipped, most adults with diabetes did visit primary care physicians.  I argued that these findings suggest that screening for diabetic retinopathy in primary care settings using telemedicine has the potential to fulfill unmet needs and reach most U.S. adults with diabetes.

My brief report in JAMA Ophthalmology examines patterns of eye examination receipt and visits to primary care physicians among U.S. adults with diabetes using a sample from the 2016 National Health Interview Survey.  The report pays particular attention to individuals who are at high-risk of missing recommended eye exams.

The study found that 87.7% of the sample of adults with diabetes visited a primary care physician in the past year and that, except for the uninsured subgroup, more than 78% of each high-risk subgroup visited a primary care provider in the past year. 

MedicalResearch.com: What should readers take away from your report? 

Response: This report adds further evidence that screening for diabetic retinopathy in primary care settings could potentially provide timely screening to a large portion of U.S adults with diabetes, including those at high-risk of missing recommended eye examinations.  This is important because timely screening increases the likelihood of the early detection and timely treatment of diabetic retinopathy.   

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response:  There are many potential barriers to the implementation of primary care-based screening for diabetic retinopathy using telemedicine including high equipment costs, primary care capacity constraints, varied insurance reimbursement and the need for secure and confidential image acquisition, transfer and storage systems.  The paper, “The Current State of Teleophthalmology in the United States,” by Siddarth Rathi and colleagues (Ophthalmology 2017;124:1729-1734) includes a very nice discussion of these and other barriers.  A recommendation for future research is to try to understand which barriers primary care providers find to be the most salient and why and how they could be overcome.  Another important area for future research is to determine what types of interventions could increase the receipt of recommended follow-up care.  ​ 

I do not have any disclosures.

Citation:  

Gibson DM. Estimates of the Percentage of US Adults With Diabetes Who Could Be Screened for Diabetic Retinopathy in Primary Care Settings. JAMA Ophthalmol. Published online January 31, 2019. doi:10.1001/jamaophthalmol.2018.6909

Feb 1, 2019 @ 12:25 am 

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One thought on “Primary Care Settings Offer Opportunity for Wider Screening for Diabetic Retinopathy

  1. Diabetic retinopathic screening is only 1 part of a yearly eye exam. Measuring eye pressure for glaucoma screening, and evaluation of vision is left undone.
    Asking the primary care doctor to do this test takes time and resources away from other aspects of diabetic care, and may reduce the overall eye care received by patients.

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