A Randomized Controlled Trial to Increase Diabetic Retinopathy Screening by a Community-Based Health Insurance Plan in Central Texas–2017

Abstract

Purpose: Diabetic retinopathy is a leading cause of blindness worldwide. In the United States, the prevalence of diabetic retinopathy is 26%–33%. Providing preventive care to individuals with diabetes is important to prevent microvascular complications in the eye. This study reports on the results of a randomized controlled trial to determine how using specific cues to action combined with the provision of a free eye exam might positively influence the rate of diabetic retinopathy screening among individuals with diabetes. Methods: Individuals were eligible to participate in this campaign if they had a diagnosis of type 2 diabetes or were prescribed a diabetes drug, were members of the health insurance plan during the intervention period and had no evidence of receiving a retinal eye exam prior to the campaign period. The six-week campaign period started on September 19, 2017 and ended on October 31, 2017. A total of 1,454 individuals with type 2 diabetes were randomly assigned to a control group or to one of three intervention groups. Each intervention group included the provision of a free eye exam. Results: A total of 148 (10.1%) individuals obtained a retinal eye exam during the six-week campaign period with 38 persons (6.8%) in the control group, 38 (15.3%) in the incentive group, 41 (16.5%) in the education group, and 31 (12.4%) in the incentive and education group. Individual intervention comparisons with the referent group yielded statistical significance using the adjusted pairwise alpha of P = .008 for the incentive group (RR = 2.08; 95% CI, 1.36–3.19; P =.0006) and for the education group (RR = 2.23; 95% CI, 1.47–3.39; P =.0001), but not in the incentive plus education group (RR = 1.73; 95% CI, 1.10–2.73; P =.017). Conclusion: This study supports the use of targeted cues to action combined with the provision of a free eye exam to increase the rates of diabetic retinopathy screening among individuals with diabetes who have health insurance coverage under the Affordable Care Act in a Central Texas population.