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Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases.
Ophthalmology. 2014 Dec; 121(12):2452-60.O

Abstract

OBJECTIVE

To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM).

DESIGN

Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS).

PARTICIPANTS

The sample consisted of 2151 Medicare beneficiaries who responded to the HRS.

METHODS

Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination.

MAIN OUTCOME MEASURES

The primary outcome measure was the number of 15-month periods with an eye examination.

RESULTS

One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations.

CONCLUSIONS

Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.

Authors+Show Affiliations

Department of Economics, Duke University, Durham, North Carolina. Electronic address: fsloan@duke.edu.Department of Economics, Duke University, Durham, North Carolina.Department of Economics, Duke University, Durham, North Carolina.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25208856

Citation

Sloan, Frank A., et al. "Gaps in Receipt of Regular Eye Examinations Among Medicare Beneficiaries Diagnosed With Diabetes or Chronic Eye Diseases." Ophthalmology, vol. 121, no. 12, 2014, pp. 2452-60.
Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology. 2014;121(12):2452-60.
Sloan, F. A., Yashkin, A. P., & Chen, Y. (2014). Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology, 121(12), 2452-60. https://doi.org/10.1016/j.ophtha.2014.07.020
Sloan FA, Yashkin AP, Chen Y. Gaps in Receipt of Regular Eye Examinations Among Medicare Beneficiaries Diagnosed With Diabetes or Chronic Eye Diseases. Ophthalmology. 2014;121(12):2452-60. PubMed PMID: 25208856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. AU - Sloan,Frank A, AU - Yashkin,Arseniy P, AU - Chen,Yiqun, Y1 - 2014/09/07/ PY - 2014/04/30/received PY - 2014/06/24/revised PY - 2014/07/14/accepted PY - 2014/9/12/entrez PY - 2014/9/12/pubmed PY - 2015/1/27/medline SP - 2452 EP - 60 JF - Ophthalmology JO - Ophthalmology VL - 121 IS - 12 N2 - OBJECTIVE: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). DESIGN: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). PARTICIPANTS: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. METHODS: Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. MAIN OUTCOME MEASURES: The primary outcome measure was the number of 15-month periods with an eye examination. RESULTS: One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. CONCLUSIONS: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/25208856/Gaps_in_receipt_of_regular_eye_examinations_among_medicare_beneficiaries_diagnosed_with_diabetes_or_chronic_eye_diseases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(14)00624-1 DB - PRIME DP - Unbound Medicine ER -