News in ophthalmology : Estimates of the Percentage of US Adults With Diabetes Who Could Be Screened for Diabetic Retinopathy in Primary Care Settings

by: Diane M. Gibson, PhD1 

JAMA Ophthalmol.  Published online January 31, 2019. doi:10.1001/jamaophthalmol.2018.6909 

Key Points
Question  What percentage of US adults with diabetes and those at high risk of missing recommended eye examinations have contact with primary care physicians and could potentially receive screening for diabetic retinopathy in primary care settings?

Findings  In this study using a sample of adults with self-reported diabetes from the 2016 National Health Interview Survey, 87.7% of the full sample and more than 78% of each high-risk subgroup, except the uninsured subgroup, visited a primary care physician in the past year.

Meaning  Screening for diabetic retinopathy in primary care settings has the potential to reach most US adults, including high-risk adults, with diabetes.
 

Abstract 
 
Importance  Prior studies found that screening for diabetic retinopathy (DR) in primary care settings using telemedicine increased screening rates among individuals with diabetes. This finding has led to interest in expanding the use of primary care–based screening for DR.

Objective  To estimate the percentages of US adults with diabetes and high-risk US adults with diabetes who have regular contact with primary care physicians and therefore could potentially receive timely screening for DR in primary care settings.

Design, Setting, and Participants  The empirical analyses used data from the cross-sectional population-based 2016 National Health Interview Survey on US adults 18 years or older with self-reported diabetes (n = 3229). Based on previous research, individuals who had lower income, lower educational levels, or type 2 diabetes; who were African American or Hispanic, uninsured, or not using insulin or oral medication for diabetes; or who did not have DR were defined as being at high risk of missing recommended eye examinations. Data were collected throughout 2016 and analyzed from July 17 through November 5, 2018.

Main Outcomes and Measures  Outcomes were whether an individual visited a primary care physician and whether an individual missed having a dilated eye examination in the past year.

Results  The survey sample included 3229 participants. Using weighted percentages of the full sample, 15.3% (95% CI, 13.8%-17.0%) had lower income, 19.7% (95% CI, 17.8%-21.6%) had lower educational levels, 15.4% (95% CI, 13.5%-17.4%) were African American, 16.0% (95% CI, 13.7%-18.6%) were Hispanic, 6.1% (95% CI, 4.9%-7.5%) were uninsured, and 50.1% (95% CI, 47.7%-52.4%) were female; the mean age was 60.1 years (95% CI, 59.4-60.8 years). In addition, 87.7% (95% CI, 85.9%-89.3%) visited a primary care physician in the past year. Of those who did not receive a dilated eye examination in the past year, 82.2% (95% CI, 78.4%-85.4%) visited a primary care physician during the year. Except for the uninsured subgroup, more than 78% of each high-risk subgroup had visited a primary care physician in the past year.

Conclusions and Relevance  Screening for DR in primary care settings has the potential to provide timely screening to a large portion of US adults with diabetes because most US adults with diabetes, including those at high-risk of missing recommended eye examinations, have regular contact with primary care physicians.

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