Primary care physicians' practice patterns and diabetic retinopathy. Current levels of care
S. K. Kraft, D. G. Marrero, E. N. Lazaridis, N. Fineberg, C. Qiu and C. M. Clark Jr
Diabetes Research and Training Center, Indiana University School of Medicine, Indianapolis, USA.
BACKGROUND: Diabetic retinopathy is a costly and prevalent complication of
diabetes mellitus. OBJECTIVE: To assess primary care physicians'
self-reported practice patterns for the screening and detection of diabetic
retinopathy relative to published guidelines. PARTICIPANTS AND METHODS: All
primary care physicians (defined as general internists, family
practitioners, and general practitioners) in Indiana were identified and
surveyed using a mailed questionnaire. Of 2390 physicians, 1508 (63%)
responded and were determined to be eligible. Of these 1508 physicians,
1058 (70%) completed all or some of the eye care-related questions. For
each eye care practice, physicians were asked to specify the proportion of
patients to which the practice was applied and the frequency (eg, every 3
months) with which the behavior was performed, if appropriate. Physicians
were also asked to distinguish between patients with type I
(insulin-dependent) and type II (non-insulin-dependent) diabetes mellitus
for each practice behavior. RESULTS: Physicians' responses were classified
as "high," "moderate," or "low" based on the American Diabetes Association
guidelines. Forty-five percent of the physicians' responses were classified
as high for referring all of their patients with type I diabetes mellitus
to an eye care specialist annually as were 35% of the physicians' responses
for referring their patients with type II diabetes mellitus. Fewer
physicians reported high levels of routine in-office funduscopic
examination. No relationship was found between the extent to which
physicians performed an in-office funduscopic examination and patterns of
referral to eye care specialists. Logistic regression analysis suggested
that recent graduates and general internists are most likely to report
behavior that is considered high (P < .05). CONCLUSION: The diabetic
retinopathy-related practice patterns of primary care physicians in Indiana
differ significantly from published guidelines.
