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- Publisher Website: 10.1016/j.ophtha.2012.11.024
- Scopus: eid_2-s2.0-84878620188
- PMID: 23583166
- WOS: WOS:000320650700031
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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
Title | Screening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law |
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Authors | |
Issue Date | 2013 |
Citation | Ophthalmology, 2013, v. 120 n. 6, p. 1247-1253 How to Cite? |
Abstract | Objective: 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 Identifier | http://hdl.handle.net/10722/195144 |
ISSN | 2023 Impact Factor: 13.1 2023 SCImago Journal Rankings: 4.642 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lian, JX | - |
dc.contributor.author | McGhee, SM | - |
dc.contributor.author | Gangwani, RA | - |
dc.contributor.author | Hedley, AJ | - |
dc.contributor.author | Lam, CLK | - |
dc.contributor.author | Yap, MKH | - |
dc.contributor.author | Lai, WW | - |
dc.contributor.author | Chu, DWS | - |
dc.contributor.author | Wong, DSH | - |
dc.date.accessioned | 2014-02-25T01:40:14Z | - |
dc.date.available | 2014-02-25T01:40:14Z | - |
dc.date.issued | 2013 | - |
dc.identifier.citation | Ophthalmology, 2013, v. 120 n. 6, p. 1247-1253 | - |
dc.identifier.issn | 0161-6420 | - |
dc.identifier.uri | http://hdl.handle.net/10722/195144 | - |
dc.description.abstract | Objective: 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.language | eng | - |
dc.relation.ispartof | Ophthalmology | - |
dc.title | Screening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1016/j.ophtha.2012.11.024 | - |
dc.identifier.pmid | 23583166 | - |
dc.identifier.scopus | eid_2-s2.0-84878620188 | - |
dc.identifier.hkuros | 223913 | - |
dc.identifier.hkuros | 264027 | - |
dc.identifier.volume | 120 | - |
dc.identifier.issue | 6 | - |
dc.identifier.spage | 1247 | - |
dc.identifier.epage | 1253 | - |
dc.identifier.isi | WOS:000320650700031 | - |
dc.identifier.f1000 | 718000251 | - |
dc.identifier.issnl | 0161-6420 | - |