Self-reported Receipt of Dilated Fundus Examinations Among Patients With Diabetes: Medicare Expenditure Panel Survey, 2002-2013.

Abstract

To evaluate self-reported adherence to diabetic retinopathy screening examinations among diabetic subjects. Retrospective, population-based cross-sectional study. Medical Expenditure Panel Survey (MEPS) consolidated full-year and prescribed drugs data from 2002-2013 were reviewed; multivariable logistic regression was used to identify patient characteristics as potential barriers to receiving examinations. Of 13 299 persons in the MEPS sample, only 39.62% (95% confidence interval [CI] 38.56%-40.67%) reported receiving annual dilated eye examinations, and 90.31% (CI 89.70%-90.91%) reported ever having received an eye examination. Significant factors related to ever receiving an eye examination included completed high school (odds ratio [OR] = 1.53; CI, 1.33-1.75), bachelor's degree or higher (OR = 1.94; CI, 1.56-2.41), private health insurance (OR = 2.07; CI, 1.70-2.52), public insurance (OR = 1.90; CI, 1.56-2.31), household income >400% of the poverty threshold (OR = 1.75; CI, 1.36-2.25), prescribed diabetes medication (OR = 1.45; CI, 1.27-1.65), diabetic kidney disease (OR = 1.31; CI, 1.08-1.59), prior foot examination (OR = 1.49; CI, 1.28-1.74), prior hemoglobin A1c test (OR = 1.45; CI, 1.28-1.64), and having a usual care provider (OR = 1.50; CI, 1.25-1.80). Self-reported Asian ethnicity (OR = 0.51; CI, 0.39-0.65), needing assistance for at least 3 months (OR = 0.79; CI, 0.62-1.00), and proxy needed to fill out the survey (OR = 0.72; CI, 0.61-0.85) were associated with lower odds of reporting ever having received a dilated eye examination. In this national-representative sample, 90.31% of patients with diabetes reported ever having a dilated eye examination; only 39.62% reported receiving one annually as recommended. These low rates appear associated with possibly modifiable factors, including having a regular care provider, increasing access to care, enrollment in health insurance, and higher education.