Prospective Randomized Controlled Trial Comparing the Outcomes and Costs of Two Eyecare Adherence Interventions in Diabetes Patients

Objective Diabetic retinopathy is one of the leading causes of vision impairment among adults in the USA. While it is suggested that diabetics receive annual dilated fundus examinations (DFE), many patients do not adhere to these recommendations. This paper investigates the outcomes and costs of an...

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Bibliographic Details
Published in:Applied health economics and health policy 2015-04, Vol.13 (2), p.253-263
Main Authors: Pizzi, Laura T., Zangalli, Camila S., Murchison, Ann P., Hale, Nicole, Hark, Lisa, Dai, Yang, Leiby, Benjamin E., Haller, Julia A.
Format: Article
Language:English
Subjects:
Age
Aged
Automation
Brochures
Clinical outcomes
Comparative analysis
Cost analysis
Costs
Costs and Cost Analysis
Diabetes
Diabetic retinopathy
Diabetic Retinopathy - economics
Diabetic Retinopathy - prevention & control
Electronic health records
Eye diseases
Eye examinations
Female
Health Administration
Health care expenditures
Health Economics
Humans
Intervention
Male
Medical records
Medicine
Medicine & Public Health
Middle Aged
Original Research Article
Patient Compliance
Patient Education as Topic - economics
Patients
Pharmacoeconomics and Health Outcomes
Postal Service
Prospective Studies
Public Health
Quality of Life Research
Reminder Systems
Schedules
Scheduling
Studies
Telephone
Visual impairment
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Summary:Objective Diabetic retinopathy is one of the leading causes of vision impairment among adults in the USA. While it is suggested that diabetics receive annual dilated fundus examinations (DFE), many patients do not adhere to these recommendations. This paper investigates the outcomes and costs of an educational and telephone intervention on DFE follow-up adherence in patients with diabetes. Methods In a prospective trial, 356 diabetic patients due for a DFE at an urban eye clinic were randomly assigned to usual care (UC; reference case), mailed intervention (MI), or telephone intervention (TI). UC patients ( n  = 119) received a standard form letter. MI patients ( n  = 117) received a personalized letter encouraging scheduling of an eye examination with an educational brochure about diabetic eye disease. TI patients ( n  = 120) received personal calls (up to three attempts) to schedule a follow-up with standard form letter. The primary outcome was obtaining a DFE within 90 days of suggested return. Costs (US$ 2013) included time costs for staff, phone charges, supplies, and postage. Since TI involved greater cost components compared to MI, univariate sensitivity analysis examined the impact of reducing phone costs. Results Patients were mostly female (66 %) and African American (70 %) with a mean age of 61 years. TI patients were more likely to schedule DFE [65 vs. 42 %; relative risk (RR) 1.54; CI 1.20–1.96; P  
ISSN:1175-5652
1179-1896
DOI:10.1007/s40258-015-0159-4