![]() 5 Previous studies using standardized training and testing protocols have demonstrated that fundoscopy can be an effective DR screening tool in primary care. Primary care professionals (PCPs)-defined as physicians, nurse practitioners, and physician assistants involved in the provision of primary care medical services-have a central role in DR screening, especially in settings where access to specialty eye care is limited. However, despite the use of myriad public health strategies to improve DR screening rates, such as full Medicare coverage for DR screening, at least 40% of patients in the United States do not receive recommended screenings for DR. 1 The American Academy of Ophthalmology 2 and the American Diabetes Association 3 recommend regular eye screenings performed by eye care professionals (ophthalmologists or optometrists) to prevent vision loss from DR. Because the rate of DR screening by eye care professionals remains low, research to explore and break down barriers to the implementation of effective primary care–based DR screening strategies, such as teleretinal imaging, is needed to prevent vision loss from undiagnosed DR.ĭiabetic retinopathy (DR) is the leading cause of blindness in working-age adults (aged 20-74 years) in the US. In multivariable logistic regression, the number of PCP years in practice was associated with greater odds of patients receiving fundoscopy at least once in the year (adjusted odds ratio per 10 years in practice, 1.26 95% CI, 1.01-1.59 P = .04) having nurse practitioner credentials was associated with lower odds of receiving fundoscopy (adjusted odds ratio, 0.23 95% CI, 0.04-0.79 P = .049 compared with having physician credentials) after adjusting for rural clinic location, clinic location in a primary care shortage area, and documentation of an up-to-date eye care professional examination by a PCP in the study year.Ĭonclusions and Relevance In this cohort study, fundoscopic examination was rarely performed and was not sensitive for detecting DR in primary care practice. No patient demographic or clinical characteristics were associated with PCPs performing fundoscopy. When eye care professional examination results were used as the reference standard, the accuracy of PCP fundoscopic examination was 62.7% (95% CI, 50.0%-73.9%) and sensitivity for detecting disease was 0.0% (95% CI, 0.0%-14.9%). Primary care professionals documented a fundoscopic examination for 93 patients (12.1%) all results were documented as normal. Results Among the 767 adult patients with diabetes included in the analysis, 387 (50.5%) were female, and the median age was 64 years (IQR, 54-71 years). The PCP examination results were compared with diagnoses made by eye care professionals to assess the sensitivity and accuracy of the findings from PCP examinations. Univariate and multivariable logistic regression analyses were performed to identify patient, clinician, and clinic factors associated with PCPs performing fundoscopy at least once in the calendar year. Main Outcomes and Measures The frequency of PCPs performing fundoscopy at least once in the calendar year for patients with diabetes. Data analysis was performed from January 2021 to May 2022.Įxposure Fundoscopic examination by PCPs. Data from 2001 encounters were abstracted from the electronic health record for a random sample of 767 patients. From a single-institution primary care network of 28 clinics, 7449 adult patients with diabetes seen at least once in the primary care network in 2019 were eligible for this study. Objectives To assess the practice patterns of fundoscopic examination for DR screening in a large primary care network and to evaluate the sensitivity and accuracy of PCP fundoscopy for detecting DR.ĭesign, Setting, and Participants A retrospective cohort study was performed using random sampling and manual review of electronic health records of PCP fundoscopic examination documentation compared with documentation of an examination performed by an eye care professional (ophthalmologist or optometrist) within 2 years before or after primary care encounters. Data on current DR screening practice patterns in primary care are needed to inform screening strategies. Importance Primary care professionals (PCPs) have a central role in screening for diabetic retinopathy (DR), especially in settings where access to specialty eye care is limited. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography.
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