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Storey, Philip P. MD, MPH*,†; Murchison, Ann P. MD, MPH*,‡; Pizzi, Laura T. PharmD, MPH§; Hark, Lisa A. PhD, RD*,‡; Dai, Yang MS; Leiby, Benjamin E. PhD; Haller, Julia A. MD*,‡

doi: 10.1097/IAE.0000000000000652
Original Study

Purpose: To evaluate the effect of written communication between an ophthalmologist and a primary care physician (PCP) on patient adherence to diabetic eye examination recommendations.

Methods: In a retrospective cohort study of a multiethnic population at an urban ophthalmology center, records of all patients with diabetes and clinic visits between 2007 and 2010 were reviewed. Data collected included patient demographics, insurance status, hemoglobin A1C, severity of diabetic retinopathy, follow-up examinations, and written communication between a patient's ophthalmologist and PCP. Statistical analyses were performed to examine the relationship between physician communication and adherence to diabetic eye examination based on the American Academy of Ophthalmology–published recommendations.

Results: A total of 1,968 people with diabetes were included. Written communication from an ophthalmologist to a PCP was associated with increased adherence to follow-up eye examination recommendations (Odds Ratio: 1.49; 95% Confidence Interval: 1.16–1.92; P = 0.0018). Communication from a PCP to an ophthalmologist was also associated with increased adherence (Odds Ratio: 1.94; 95% Confidence Interval: 1.37–2.77; P = 0.0002). Multivariable analysis controlling for other factors associated with examination adherence confirmed that communication both to and from an ophthalmologist was independently and significantly associated with increased follow-up adherence.

Conclusion: Patients with communication between ophthalmologists and PCPs are more likely to adhere to diabetic eye examinations.

In a retrospective cohort study of 1,968 people with diabetes, written communication from an ophthalmologist to a primary care physician, as well as communication from a primary care physician to an ophthalmologist, was found to be independently and significantly associated with increased adherence to follow-up diabetic eye examination recommendations.

*Wills Eye Hospital, Philadelphia, Pennsylvania;

USC Eye Institute, University of Southern California, Los Angeles, California;

Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and

§Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania.

Reprint requests: Julia A. Haller, MD, Wills Eye Hospital, 840 Walnut Street, Suite 1510, Philadelphia, PA 19107; e-mail:

Supported by a cooperative agreement with the Centers for Disease Control and Prevention, grant number: 1U58DP002655-01.

None of the authors have any financial/conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.