PRESENTING AUTHOR

Diabetic retinopathy is a leading cause of blindness worldwide. Point-of-care examination with nonmydriatic retinal cameras has emerged as an option to tackle barriers to eye care. However, adherence to follow-up recommendations vary across settings. There is scarce information on influencing factors for adherence. This study aims to identify associated factors with lack of follow-up in a point-of-care program in the United States.

We conducted a non-concurrent retrospective cohort study to analyze follow-up adherence within six months of undergoing diabetic retinopathy examination (DRE). Included participants were aged ≥18, underwent DRE at 35 primary care clinics, and were advised to follow-up after the screening. Data from January 2 017 to December 2 019 were collected from electronic medical records, focusing on socioeconomic, clinical, and system-level factors. A clustered multivariate logistic regression was used to identify variables associated with non-compliance in follow-up.

Out of 3,131 patients advised to follow up, 32.3% did so with an eye care provider. Communication methods, such as email (Adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.23-0.84) and phone calls (aOR=0.28, 95%CI:=0.15-0.52), were a protective factor against loss to follow-up. An increased likelihood of non-follow-up was observed in older individuals (aOR=1.02, 95%CI=1.00-1.03) and when DRE result reporting was delayed beyond two days (aOR=1.81, 95%CI=1.05-3.11).

Sociodemographic factors, particularly older age, significantly influence follow-up rates. System-level factors, especially the method and timing of communication regarding DRE results, are crucial in determining patient adherence. Testing of interventions to address the study findings are required for enhancing follow-up adherence.