Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases.
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.
Type
Journal articleSubject
Activities of Daily LivingAged
Attitude to Health
Chronic Disease
Diabetes Mellitus
Diabetic Retinopathy
Female
Glaucoma
Health Behavior
Health Care Surveys
Health Services
Health Services Accessibility
Humans
Macular Degeneration
Male
Medicare
Middle Aged
Patient Acceptance of Health Care
Retrospective Studies
Sex Factors
United States
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https://hdl.handle.net/10161/14810Published Version (Please cite this version)
10.1016/j.ophtha.2014.07.020Publication Info
Sloan, Frank A; Yashkin, Arseniy P; & Chen, Yiqun (2014). Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed
with diabetes or chronic eye diseases. Ophthalmology, 121(12). pp. 2452-2460. 10.1016/j.ophtha.2014.07.020. Retrieved from https://hdl.handle.net/10161/14810.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Frank A. Sloan
J. Alexander McMahon Distinguished Professor Emeritus of Health Policy and Management
Professor Sloan is interested in studying the subjects of health policy and the economics
of aging, hospitals, health, pharmaceuticals, and substance abuse. He has received
funding from numerous research grants that he earned for studies of which he was the
principal investigator. His most recent grants were awarded by the Robert Wood Johnson
Foundation, the Center for Disease Control, the Pew Charitable Trust, and the National
Institute on Aging. Titles of his projects include, “Why Mature S
Arseniy Yashkin
Research Scientist, Senior
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