Managed care and eye services to diabetic patients: a study of participant behavior

Effective managed care requires the active participation of health professionals and patients alike. The essential elements in management of diabetes involve well-defined professional clinical protocols, adequate patient education, and adherence to these management guidelines by all parties. This study was designed to evaluate how well the involved parties cooperate in this endeavor.

Health plan records were searched for identified diabetic patients. This information was cross-referenced to vision care claims information. Clinical records of diabetic patients who had an eye examination during the study period were peer-reviewed for evidence of a diabetes notation.

Of 2825 diabetic patients identified, we obtained the clinical eye records of 554 for review. Seventy percent of those records noted the presence of diabetes. Ninety-seven percent of the eye examinations included a funds evaluation. Only 56% of records noted any patient education or-- at a minimum--notations about recall advice.

The nature of diabetes requires that health professionals be more aggressive in the management of individuals at risk or diagnosed with diabetes.