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Article: Screening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law

TitleScreening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law
Authors
Issue Date2013
Citation
Ophthalmology, 2013, v. 120 n. 6, p. 1247-1253 How to Cite?
AbstractObjective: To examine whether the inverse care law operates in a screening program for diabetic retinopathy (DR) based on fee for service in Hong Kong. Design: Randomized controlled trial. Participants: All those with type 1 or 2 diabetes from 2 clinics were recruited. Intervention: Diabetic retinopathy screening with a small copayment versus free access in a publicly funded family medicine service. Main Outcome Measures: Uptake of screening and severity of DR detected. Association between these outcome variables and independent variables were determined using multivariate logistic regression models and reported as odds ratios (ORs). Results: After randomization, 1387 subjects in the free group and 1379 subjects in the pay group were eligible for screening, and 94.9% (1316/1387) and 92.6% (1277/1379), respectively, agreed to participate in the study. The offer of screening was accepted by 94.8% (1247/1316) in the free group and 91.2% (1164/1277) in the pay group, and the final uptake ratios were 88.5% (1165/1316) and 82.4% (1052/1277), respectively (Pearson chi = 19.74, P<0.001). Being in the pay group was associated with a lower uptake of screening than being in the free group (OR, 0.59; confidence interval [CI], 0.47-0.74) and a lower detection rate of DR (OR, 0.73; CI, 0.60-0.90) after adjustment for potential confounding factors. Subjects with higher socioeconomic status were more likely to attend screening and had a lower prevalence of DR detected. Conclusions: The inverse care law seems to operate in a preventive intervention when a relatively small copayment is applied. There is a case for making effective preventive services free of charge. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.
Persistent Identifierhttp://hdl.handle.net/10722/195144
ISSN
2015 Impact Factor: 6.75
2015 SCImago Journal Rankings: 4.745
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLian, JX-
dc.contributor.authorMcGhee, SM-
dc.contributor.authorGangwani, RA-
dc.contributor.authorHedley, AJ-
dc.contributor.authorLam, CLK-
dc.contributor.authorYap, MKH-
dc.contributor.authorLai, WW-
dc.contributor.authorChu, DWS-
dc.contributor.authorWong, DSH-
dc.date.accessioned2014-02-25T01:40:14Z-
dc.date.available2014-02-25T01:40:14Z-
dc.date.issued2013-
dc.identifier.citationOphthalmology, 2013, v. 120 n. 6, p. 1247-1253-
dc.identifier.issn0161-6420-
dc.identifier.urihttp://hdl.handle.net/10722/195144-
dc.description.abstractObjective: To examine whether the inverse care law operates in a screening program for diabetic retinopathy (DR) based on fee for service in Hong Kong. Design: Randomized controlled trial. Participants: All those with type 1 or 2 diabetes from 2 clinics were recruited. Intervention: Diabetic retinopathy screening with a small copayment versus free access in a publicly funded family medicine service. Main Outcome Measures: Uptake of screening and severity of DR detected. Association between these outcome variables and independent variables were determined using multivariate logistic regression models and reported as odds ratios (ORs). Results: After randomization, 1387 subjects in the free group and 1379 subjects in the pay group were eligible for screening, and 94.9% (1316/1387) and 92.6% (1277/1379), respectively, agreed to participate in the study. The offer of screening was accepted by 94.8% (1247/1316) in the free group and 91.2% (1164/1277) in the pay group, and the final uptake ratios were 88.5% (1165/1316) and 82.4% (1052/1277), respectively (Pearson chi = 19.74, P<0.001). Being in the pay group was associated with a lower uptake of screening than being in the free group (OR, 0.59; confidence interval [CI], 0.47-0.74) and a lower detection rate of DR (OR, 0.73; CI, 0.60-0.90) after adjustment for potential confounding factors. Subjects with higher socioeconomic status were more likely to attend screening and had a lower prevalence of DR detected. Conclusions: The inverse care law seems to operate in a preventive intervention when a relatively small copayment is applied. There is a case for making effective preventive services free of charge. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.-
dc.languageeng-
dc.relation.ispartofOphthalmology-
dc.titleScreening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ophtha.2012.11.024-
dc.identifier.pmid23583166-
dc.identifier.scopuseid_2-s2.0-84878620188-
dc.identifier.hkuros223913-
dc.identifier.hkuros264027-
dc.identifier.volume120-
dc.identifier.issue6-
dc.identifier.spage1247-
dc.identifier.epage1253-
dc.identifier.isiWOS:000320650700031-
dc.identifier.f1000718000251-

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