Barriers to Follow-Up After Teleretinal Screening for Diabetic Retinopathy in the Harris Health System Open Access

Abstract

Introduction: The Harris Health System implemented a teleretinal screening (TS) program for diabetic retinopathy in 2013. However, rates of follow-up after screening are suboptimal with only approximately half of those referred after TS completing follow-up. This study aimed to understand the barriers patients face in successfully completing follow-up after TS.

Methods: A retrospective cohort analysis of patients screened by non-mydriatic fundus photography via the Intelligent Retinal Imaging System (IRIS) at 13 Harris Health primary care clinics in 2018 was conducted. From this initial cohort of 11,622 patients, 333 patients who were identified by TS as having sight-threatening diabetic eye disease (STDED) failed to complete a follow-up appointment with a retina specialist at Ben Taub General Hospital or Lyndon B. Johnson Hospital. This cohort was contacted, and 103 patients voluntarily completed a 13-question telephone survey assessing barriers to follow-up.

Results: The overall loss to follow-up rate (LTFU) was 37.37%. Survey results indicate that the most common barriers to follow-up are healthcare-related costs and lack of instructional clarity following TS. Our analysis found no statistically significant relationship between language preference of survey respondent, location of TS, or the age/sex/race of survey respondent and the number of barriers reported. Increased risk of LTFU was found in those patients screened at 3 primary care clinics: Baytown (RR 1.37, 95% CI 1.01-1.86), Casa De Amigos (RR 1.32, 95% CI 1.01-1.72), and Squatty Lyons (RR 1.37, 965% CI 1.01-1.87).

Discussion: Our analysis found that the suboptimal follow-up rate of 62.63% among patients with TS-identified STDED is due in large part to systemic barriers many patients face, ranging from transportation and childcare demands to cost and lack of comprehension of post-screening instructions. Future quality improvement interventions, such as a refined process in providing patient instructions, will be developed based on these findings.

Table of Contents

Introduction……………………………………………………………..………………….........1

Methods………………………………………………………..…………………………………7

Results……………………………………………………………………..…………………….13

Discussion…………………………………………………..…………………………………..23

References………………………………………………………………...…………………….29

Tables……………………………………………………...…………………………………….35

Figures……………………………………………………………..……………………………39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	B.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Ophthalmology
Keyword	Ophthalmology
Committee Chair / Thesis Advisor	Dr. Carolyn Drews-Botsch , Emory University
Committee Members	Dr. Christina Y. Weng, Baylor College of Medicine

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