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Qualitative Study of Patients and Physicians

M. Elizabeth Hartnett, MD; Ira J. Key, CPHQ; Natalie M. Loyacano, COT, CSA; Ronald L. Horswell, PhD; Karen B. DeSalvo, MD, MPH, MSc

Arch Ophthalmol. 2005;123:387-391.

Objectives  To address inadequate retinopathy screening at a largely indigent clinic and to explore perceived barriers, using qualitative techniques.

Methods  Responses were analyzed from structured focus groups of patients and key informant interviews of primary diabetic physicians and ophthalmologists at the Medical Center of Louisiana in New Orleans. The number of diabetic patients screened at the center from 2000 to 2002 was obtained by quantitative analysis of an administrative database.

Results  Participants cited finances as the major barrier, while physicians cited inadequate patient education. Patients largely believed that diabetic education was adequate, yet there was a gap between patient education provided and their understanding. All sources agreed that poor access to care, particularly the 1-year wait for an appointment, was a barrier. No respondent mentioned constraints of the system to provide eye care to the number of diabetic patients as a possible barrier, despite the 1-year wait for an eye appointment and a 29% increase in eye examinations within 2 years.

Conclusions  Perceptions of barriers to diabetic eye care differed among physicians and patients, although both groups agreed that access to care was a barrier. A gap exists between educational material provided to patients and what patients understand. A large unrecognized workload stresses the capacity of the current system.

Author Affiliations: Department of Ophthalmology, The University of North Carolina at Chapel Hill (Dr Hartnett); Department of Ophthalmology, Louisiana State University Eye Center, Louisiana State University Health Sciences Center, New Orleans (Dr Hartnett and Ms Loyacano); Health Care Services Division, Louisiana State University Health Sciences Center, Baton Rouge (Mr Key and Dr Horswell); and Department of Medicine, Tulane University Health Sciences Center, New Orleans (Dr DeSalvo).

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