Dilated Eye Exam Research Articles

265 Rethinking the Standard of Care for Patients With Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is an emergency causing unilateral, sudden, painless vision loss. Although generally due to thromboembolic vascular occlusion of arteries in the cerebral circulation, CRAO has historically not been worked up in the same manner as a thromboembolic stroke. Recently, there has been a push for stroke workup in CRAO patients including admission, but there is little published data supporting such recommendations. We present a retrospective review of CRAO patients referred to a large urban medical center for hyperbaric oxygen therapy (HBO). These CRAO patients also received an emergency department and inpatient diagnostic workup similar to thromboembolic stroke. This review was performed to assess findings of the stroke workup in CRAO patients. Patients who presented between November 2014 and July 2016 were included in this retrospective review. Patients received a standardized workup in the emergency department that included bedside ocular ultrasound, lab draw, neurology/stroke consult, ophthalmology consult with dilated eye exam, and HBO consult. Chart review of the electronic medical record was used to compile a dataset of the co-morbidities, stroke workup, and interventions in CRAO patients. Inpatient workup included brain magnetic resonance imaging (MRI), echocardiogram, carotid imaging, lipid panel, and hemoglobin A1c. During the study period, 58 CRAO patients were treated. An acute or subacute brain infarct was identified on 15 of 47 patients (32%) who received an MRI. Intracardiac shunt was identified on 11 of 55 patients (20%) who received echocardiography. 44 of 58 patients (76%) had addition or modification of anticoagulation or antiplatelet medications. 34 of 58 patients (59%) were either started on a statin, changed to a more potent statin, or had a dose increase. Findings from carotid imaging led to interventionalist consult or follow-up for 11 of 58 patients (19%), two of whom had carotid stenting during the initial hospitalization. One patient returned with an acute thromboembolic stroke 8 days after CRAO presentation. The findings of this study strongly support recommendations that in the emergency department, CRAO patients should receive workup and treatment similar to that for thromboembolic stroke patients. The MRI findings that 32% had acute or subacute brain infarct further demonstrate the high risk of these patients necessitating workup and admission from the emergency department.

Assessment of health-related quality of life among adult patients with type 2 diabetes mellitus

<p>Introduction.The aim of the study was to find out the determinants of thequality of life in primary health care patients with type 2 diabetes.Methods. The cross-sectional study included 181 patients, aged 37 to 89 years,with diabetes mellitus type 2, registered with four family medicine practices.The assessment of health status was conducted using medical history, objectiveexamination, laboratory analyses, dilated eye exam, screening for distalsymmetric neuropathy and ankle-brachial index measurement. In evaluatingthe impact of diabetes mellitus on patients’ health status, a generic instrument,the self-administered WHOQOL-BREF questionnaire, was used. Multivariatelinear regression models were used to analyze the variables associated withthe quality of life.Results. Out of 181 adult patients with type 2 diabetes mellitus, 73 (40.3%)had diabetes for less than 5 years. The mean glycated hemoglobin (A1C) was7.55% and the mean serum levels of fasting glucose, total cholesterol, LDL-cholesterol,HDL-cholesterol and triglycerides were above the recommendedvalues. Most of the patients had comorbidities, chronic diabetes complicationsand used oral hypoglycemic agents in combination with insulin. Themultivariate regression analysis showed that the age, psychological health,nephropathy and environment were associated with the domain of physicalhealth. The determinants of psychological health were age, marital statusand environment. Older and single patients had lower scores, whereas thosewith a better living environment had higher scores in the domain of socialrelationship. The levels of glycemic control and gender have not been shownto be significant determinants of any of the four domains.Conclusion. The factors associated with the different domains of quality oflife in patients with type 2 diabetes are multiple, but mainly relate to age,living environment and diabetes complications. The results can be used as aguideline for defining measures that can improve the quality of life of patientswith type 2 diabetes</p>

Trends in sex differences in the receipt of quality of care indicators among adults with diabetes: United States 2002-2011

BackgroundEvidence suggests disparities in quality of care (QoC) indicators based on sex exist in adults diagnosed with diabetes; however, this research is limited. Therefore, the objective of this research study was to assess differences in QOC indicators in a nationally representative sample of men and women with diabetes.MethodsCross-sectional study of 17,702 men and women (≥18 years of age) with diabetes from the 2002–2011 Medical Expenditure Panel Survey Household Component. Sex was the main predictor variable, and the dependent variables were five binary indicators to measure QOC, which included testing of hemoglobin A1c, examining feet annually, getting eyes dilated, checking blood pressure, and visiting the doctor annually. Sample demographics by sex were assessed. Unadjusted analyses were computed for descriptive statistics by sex and proportions of QOC indicators over time. Logistic regression evaluated associations between QOC indicators and sex, while controlling for sociodemographic characteristics, time, and comorbid conditions.ResultsApproximately 44% and 56% of the sample was comprised of men and women, respectively. Unadjusted analyses showed significant differences in A1c testing (p < 0.001) and foot examinations (p = 0.002) for the entire sample, and significant differences in A1c testing (p = 0.027), foot examinations (p = 0.01), and dilated eye exams (p = 0.026) among men and A1c testing (p < 0.001) among women overtime. Adjusted analyses found women to be significantly more likely to have dilated eye examinations during a given year (OR = 1.14; 95% CI 1.04, 1.24), to get their blood pressure checked by a doctor in a given year (OR = 1.44; 95% CI 1.13, 1.84), and to visit a doctor annually (OR = 1.39; 95% CI 1.22, 1.58) compared to men.ConclusionsIn this sample of adults with diabetes, women had significantly higher odds of receiving quality of care compared to men. These findings suggest the importance of educating patients about appropriate metrics of diabetes management, especially men, and the need for continuous empowerment of women to receive proper and optimal care. Additional research is needed to identify causes and reduce sex and gender disparities associated with diabetes quality of care.

A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study.

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)–United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status.

Blacks, Hispanics, and Asians are disproportionately affected by diabetes. We assessed the state of racial/ethnic disparities in diabetes quality of care in the USA. We analyzed cross-sectional data of adults diagnosed with Type 2 diabetes in the nationally representative 2013 Medical Expenditure Panel Survey. Differences in adherence to five diabetes quality of care recommendations (HbA1c twice yearly, yearly foot exam, dilated eye exam, blood cholesterol test, and flu vaccination) were examined by race/ethnicity while controlling for three social determinants of health (health insurance status, poverty, and education) and other demographic variables. Among adults with diabetes in the USA, 74.9% received two or more HbA1c tests, 69.0% had a foot exam, 64.9% had an eye exam, 85.4% had a cholesterol test, and 65.1% received flu vaccination in 2013. Compared to Whites, all were lower for Hispanics; HbA1c tests, eye exam, and flu vaccination were lower for Blacks; HbA1c tests, foot exam, and eye exam were lower for Asians. In adjusted models, the only remaining disparities in quality of care indicators were HbA1c tests for Hispanics (AOR 0.67, CI=0.47-0.97), Blacks (AOR 0.59, CI=0.40-0.88), and Asians (AOR 0.47, CI=0.42-0.99); foot exams for Hispanics (AOR 0.65, CI=0.47-0.90); and flu vaccination for Blacks (AOR 0.68, CI=0.49-0.93). Lack of insurance coverage and education explained some of the racial/ethnic disparities observed in diabetes quality of care. Improving quality of diabetes care could help reduce rates of diabetes complications, healthcare costs, and mortality.

Diabetes Self-Management Behaviors among American Indians in the Midwestern United States.

The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.

The Local Availability of Eye Care Providers and the Vision Health of Adults in the United States

ABSTRACTPurpose: To examine whether the local availabilities of ophthalmologists and optometrists were associated with outcomes related to the prevention and timely treatment of vision conditions.Methods: Data on adults from the 2008 National Health Interview Survey were linked to county-level information on the numbers of ophthalmologists and optometrists per capita from the Area Health Resources File. Multivariate logistic regression models were estimated for whether individuals likely to perceive themselves as being at lower risk of vision conditions had undergone a dilated eye exam in the previous 2 years, whether individuals with diabetes had a dilated eye exam in the previous year, and whether individuals with an age-related eye disease (ARED) had lost vision due to the condition. The models included measures of local eye care provider availability and additional explanatory variables.Results: The county-level availabilities of ophthalmologists and optometrists were positively and significantly related to the likelihood that perceived lower-risk individuals had undergone a dilated eye exam in the previous 2 years. Local eye care provider availability was not significantly related to whether individuals with diabetes had a dilated eye exam in the previous year. Greater county-level availability of ophthalmologists, but not optometrists, was associated with a significantly lower likelihood that individuals with an ARED had lost vision due to the condition.Conclusion: Public health interventions may be needed in order to increase access to preventive eye care in areas with limited overall eye care provider availability and to improve the treatment of vision conditions in areas with limited ophthalmologist availability.

Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes.

Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden. African American women with type 2 diabetes enrolled in dietary and weight management interventions. Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests. Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m(2)), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65). Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.

Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India.

Aim:To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India.Methods:We interviewed physicians (n = 23) and patients with diabetes (n = 406), and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, blood pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model.Results:The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7), and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model.Conclusion:Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.

Assessing Adherence to Annual Dilated Eye Exam Recommendations in Patients with Diabetes and Erectile Dysfunction

Aims: This prospective, observational, pilot study assessed adherence rates of annual dilated fundus examinations (DFEs) among patients with diabetes mellitus (DM) and erectile dysfunction (ED) in a university-based practice and identified predictors associated with DFE adherence.

Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults.

These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims). Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms. After EHR implementation, both the overall order rates and odds ratios of per beneficiary hemoglobin A1C (HbA1C) orders increased significantly (ie, from mean of 0.65 [SD = 1.19] annual tests to 0.96 tests [SD = 1.24] [P < .001]). Although the overall post-EHR order rates of dilated eye exams and microalbumin urine tests appeared fairly stable, the odds of eye exam orders being placed at the claims level decreased significantly (OR = 0.774, P = .0030). These mixed results provide evidence of the varied diabetes care ordering patterns likely seen from increased office use of EHR technologies. The authors attempt to explain these post-EHR differences (or lack of) that generally resemble some of the authors' results from another funded project. Ideally, these findings provide Medicaid and health care officials with a more realistic indication of how EHRs may, or may not, influence diabetes care ordering patterns for vulnerable lower-income primary health care consumers.

Dilated Eye Exam Compliance for Persons With Diabetes Mellitus in a Managed Care Setting

Background/Aims: National practice guidelines recommend regular dilated eye examinations for persons with diabetes mellitus (DM). Regular exams can identify the presence of diabetic eye diseases leading to early detection and treatment along with vision preservation. We aimed to: 1) assess compliance with guideline-recommended dilated eye exams among persons with DM, and 2) determine the factors associated with noncompliance.

Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.

Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. To examine practice contextual features that moderate intervention effectiveness. Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: < 20 % vs. ≥ 20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: < 4 clinicians vs. ≥ 4 clinicians (+.56(p = .02), +1.96(p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.

Abstract 121: Testing Frequency Of Guideline-recommended Diabetes Performance Measures In A Cohort Of Post-acute Myocardial Infarction (AMI) Diabetics.

Background: Diabetes mellitus (DM) is common among patients hospitalized with acute myocardial infarction (AMI). Although guideline-supported performance measures exist to improve care for each condition, prior work assessing the quality of care for diabetic patients after AMI has focused only on adherence to CAD performance measures. The quality of diabetic care these patients’ receive is unknown. Methods: Using data from a prospective AMI registry (TRIUMPH), we identified patients with known DM and examined whether DM-focused performance measures had been applied over the 12 months after discharge. We focused upon 3 DM guideline-supported performance measures: a dilated eye exam, detailed foot exam, and HgbA1C testing. For this analysis, we conducted univariate statistics to describe the frequencies with which diabetics reported receiving these DM performance measures and 4 CAD performance measures at their 12-month interview. Results: Among 1,343 patients with a known diagnosis of diabetes presenting with an AMI, a total of 791 (58.9%) completed the 12-month follow up interview. The mean age (SD) of the analytic cohort was 6111 years, with 60% being males and 63% Caucasian. The frequencies of reported receipt among the examined DM and CAD performance measures ranged from 57.3%- 82.2%, with ASA being the most common and a dilated eye exam being the least (Figure). Only 47% of patients reported receiving all three DM performance measures over the past 12 months, while 41.1% reported receiving either one or two, and 12% reported receiving none. Conclusion: In a large, multi-center cohort of diabetic AMI survivors we found that patient-reported receipt of 3 DM and 4 CAD performance measures is sub-optimal and there is significant room for improvement. Novel strategies and approaches for assessing the quality of care delivered to post-AMI diabetics in a multidimensional fashion remains vital for improving care and outcomes in this high-risk group of patients. Characters: 1,683 + figure 500. Limit 2,500

A Review of Advances in Collaborative Pharmacy Practice to Improve Adherence to Standards of Care in Diabetes Management

The prevalence of diabetes in the United States is increasing and so is the need to provide diabetes care. Given the time commitment and complexity of diabetes management, an interdisciplinary approach is recommended. Pharmacists are integral members of the diabetes care team because of their accessibility and expertise in medication management. Pharmacists are receiving specialized training and becoming more involved in direct patient care through collaborative practice opportunities such as medication therapy management and collaborative drug therapy management. These collaborative practice models increase patient access to care and allow pharmacists to optimize drug therapy and provide important education to promote diabetes self-management. Studies show pharmacists practicing in a variety of outpatient environments can reduce HbA1c, LDL and BP as well as improve adherence to recommended American Diabetes Association guidelines (yearly monofilament exams, dilated eye exams, microalbumin screening, etc). Pharmacists working as part of the health care team can ensure optimal diabetes management.

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics

To evaluate the relative diagnostic value of nonmydriatic fundus photography (nFP) among patients screened for diabetic retinopathy in remote rural medical clinics and an urban academic medical center for nonadherence to recommended annual dilated eye examination. A retrospective cross-sectional study was performed among diabetic patients seen in primary outpatient clinics between 2006 and 2011 who were screened for diabetic retinopathy with nFP for history of nonadherence to recommended annual dilated eye examination. A single nonstereoscopic, 45°, 10-megapixel digital image of the disc and macula of both eyes was obtained locally and transmitted electronically to a retinal specialist for remote review. The results from remote rural Native American Indian reservations were compared with those from an urban academic family practice clinic. The proportion of subjects diagnosed with diabetic retinopathy and the quality of fundus images were compared. Among 872 patients (1,744 eyes) screened from rural sites and 517 subjects (1,034 eyes) screened from an urban site, images were of good quality for evaluation in 82.4% and 85.7% of subjects, respectively. Diabetic retinopathy was noted in 12.6% of rural subjects and 29.6% of urban subjects (p<0.001). nFP can be a useful tool in both rural and urban settings to screen for diabetic retinopathy in patients who are nonadherent to the recommended dilated annual eye exam. In our study population, a surprisingly higher percentage of diabetic subjects screened from the urban clinic had retinopathy compared with subjects screened in rural clinics.

Educating Future Physicians to Track Health Care Quality

Quality improvement (QI) requires measurement, but medical schools rarely provide opportunities for students to measure their patient outcomes. The authors tested the feasibility and perceived impact of a quality metric report card as part of an Education-Centered Medical Home longitudinal curriculum. Student teams were embedded into faculty practices and assigned a panel of patients to follow longitudinally. Students performed retrospective chart reviews and reported deidentified data on 30 nationally endorsed QI metrics for their assigned patients. Scorecards were created for each clinic team. Students completed pre/post surveys on self-perceived QI skills. A total of 405 of their patients' charts were abstracted by 149 students (76% response rate; mean 2.7 charts/student). Median abstraction time was 21.8 (range: 13.1-37.1) minutes. Abstracted data confirmed that the students had successfully recruited a "high-risk" patient panel. Initial performance on abstracted quality measures ranged from 100% adherence on the use of beta-blockers in postmyocardial infarction patients to 24% on documentation of dilated diabetic eye exams. After the chart abstraction assignment, grand rounds, and background readings, student self-assessment of their perceived QI skills significantly increased for all metrics, though it remained low. Creation of an actionable health care quality report card as part of an ambulatory longitudinal experience is feasible, and it improves student perception of QI skills. Future research will aim to use statistical process control methods to track health care quality prospectively as our students use their scorecards to drive clinic-level improvement efforts.

Analysis of Behavior Risk Factor Surveillance System Data to Assess the Health of Hispanics With Diabetes in US-Mexico Border Communities

The purpose of this study is to describe and compare personal characteristics, health care access and utilization, and self-management behaviors of Hispanic American adults diagnosed with diabetes who reside in 3 US-Mexico border counties in Arizona, New Mexico, and Texas. This study also examines the status of this population in attaining Healthy People (HP) 2020 diabetes target goals. Data were extracted from the 2005-2009 Selected Metropolitan/Micropolitan Area Risk Trends (SMART): Behavioral Risk Factor Surveillance System (BRFSS) to analyze behavioral and health system factors associated with diabetes management among Hispanic American adults who reside in the border counties (N = 600). Data were analyzed using descriptive statistics and compared using chi-square and one-way analysis of variance. There were significant differences in health care access and utilization and in 1 self-management behavior (daily feet checks) across the counties. The majority of participants (83.4%) had a care provider, however the HP 2020 diabetes target goals for A1C monitoring or foot exams conducted by a care provider were not met. Participants in all counties met the target goal for dilated eye exams. Improvement of diabetes management among this population should focus on border health system barriers to attaining HP 2020 diabetes target goals.

Correlates of physician trust among rural older adults with diabetes.

To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes. 563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale. Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders. Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.

Factors Contributing to Diabetes Patients Not Receiving Annual Dilated Eye Examinations

Purpose: Early detection of diabetic eye disease by dilated eye exam can limit potential vision loss from diabetic retinopathy. The purpose of this study was to examine what variables contribute to diabetes patients not receiving annual dilated eye examinations.Methods: This study used national 2009 Behavioral Risk Factor Surveillance System survey data. Variables used in the analysis included sociodemographics, insurance status, mentally unhealthy days, receipt of annual dilated eye exams, insulin dependence, a history of diabetes education classes, timely annual diabetic foot exams, and history of cardiovascular disease. Survey proportions were calculated, and survey logistic regression was performed with the consideration of survey strata and weight to correct for biases.Results: The likelihood of receiving annual dilated eye exams was correlated with eight statistically significant variables. These variables included age category, income level, education level, health insurance status, mentally unhealthy days within the past month, insulin dependence, a history of diabetic education classes, and timeliness of annual diabetic foot examinations.Conclusions: This study provides a snapshot of variables that may have a bearing on diabetes patients seeking annual dilated retinal examinations. Eight variables were statistically significant in affecting the timeliness of diabetic eye examinations. Thus, resolutions for these factors could be implemented for future improvement of comprehensive health care provided to those with diabetes.