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Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes.

ABSTRACT: Purpose:To determine the rates and develop an initial risk prediction model for nonadherence to post screening ophthalmic referral (PSOR) in type 2 diabetes mellitus (T2DM) patients attending a national diabetic retinopathy screening program in Singapore. Methods:Data from 2387 patients with T2DM (mean [standard deviation] age: 66.5 [11] years; 52.5% female patients) who underwent teleophthalmic screening between 2010 and 2014 under the Singapore Integrated Diabetic Retinopathy Program were extracted from electronic medical records. All were referred for tertiary ophthalmic management at the Singapore National Eye Centre (SNEC). Nonadherence was defined as not attending the SNEC appointment within 6 months of the assigned appointment date. Regression analysis using traditional modified Poisson and conditional inference models was used to construct and evaluate the discriminative ability of the preliminary risk prediction model to identify nonadherent individuals. Results:Nonadherence rates to PSOR was 12.7% (95% confidence interval, 11.4%-14.1%). In traditional multivariable models adjusted for sociodemographic, lifestyle, and ocular factors, nonadherent individuals had higher triglyceride levels and were less likely to have a referable eye condition (P < 0.05). This model was able to identify nonadherent individuals with an accuracy (area under the curve) of 84%. In contrast, the conditional inference model was able to achieve similar discriminative ability using only participants' ocular health characteristics. Conclusions:The rates of nonadherence to PSOR in Singaporean individuals with T2DM is low, with better ocular health being strongly predictive of nonadherence in our Asian population. Translational Relevance:Our results may inform interventions to decrease nonadherence to PSOR.

SUBMITTER: Sia JT

PROVIDER: S-EPMC7408802 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes.

Sia Josh Tjunrong JT Gan Alfred Tau Liang ATL Soh BaoLin Pauline BP Fenwick Eva E Quah Joanne J Sahil Thakur T Tao Yijin Y Tan Ngiap Chuan NC Sabanayagam Charumathi C Lamoureux Ecosse L EL Man Ryan Eyn Kidd REK

Translational vision science & technology 20200519 6

<h4>Purpose</h4>To determine the rates and develop an initial risk prediction model for nonadherence to post screening ophthalmic referral (PSOR) in type 2 diabetes mellitus (T2DM) patients attending a national diabetic retinopathy screening program in Singapore.<h4>Methods</h4>Data from 2387 patients with T2DM (mean [standard deviation] age: 66.5 [11] years; 52.5% female patients) who underwent teleophthalmic screening between 2010 and 2014 under the Singapore Integrated Diabetic Retinopathy Pr ...[more]

PMID: 32821512

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Project description:ObjectivesTo determine the prevalence of polypharmacy prescription among type 2 diabetes (T2DM) patients at a tertiary care department in Ningbo, China, and to determine factors that independently predict this polypharmacy prescription.MethodsA retrospective cross-sectional study was conducted using an existing computerised medical records database. This database was screened from 2012 to 2017 for adult patients with T2DM and parameters like prescribed medicines and socio-demographic, behavioural and other medical information. Polypharmacy prescription was defined as the simultaneous prescription of ≥5 medicines by the clinician at the time of discharge for daily usage by the patient as part of his/her long-term treatment plan.ResultsThe study inclusion criteria were satisfied by 3370 T2DM patients. Over a 5-year period, 72.2% (n = 2432) of T2DM patients were prescribed polypharmacy. On an average, eight medicines were prescribed to them. The odds of polypharmacy prescription increased with patients' age (18-39 years: 1; 40-59 years: OR 1.86, 95% CI 1.28-2.71; and ≥60 years: 2.42, 1.65-3.55), duration of T2DM (≤1 year: 1; >5-10 years: 1.70, 1.10-2.62; and >10 years: 2.55, 1.68-3.89), and length of hospital stay (≤5 days: 1; >5-10 days: 2.43, 1.86-3.17; and >10 days: 2.99, 2.24-3.99), and were higher in those with poor blood glucose level (2.09, 1.67-2.62) and with comorbidities like other endocrine, nutritional and metabolic diseases (2.24, 1.76-2.85), circulatory system diseases (4.35, 3.62-5.23), skin and subcutaneous tissue diseases (1.64, 1.04-2.59), and musculoskeletal system and connective tissue diseases (1.61, 1.27-2.03). The odds of polypharmacy prescription were lower in those with comorbidities like neoplasms (0.51, 0.36-0.70) and during pregnancy, childbirth and the puerperium (0.06, 0.01-0.49).ConclusionsAround three fourth of T2DM patients at the tertiary care department were prescribed polypharmacy, and the predictors were identified. The study findings could be taken into consideration in future interventional studies aimed at supporting medicines optimisation (and deprescribing) among these patients.

Dataset Information

Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes.

Publications

Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes.

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