Screening for diabetic retinopathy with or without a copayment in a randomized controlled trial: influence of the inverse care law.
Ophthalmology
; 120(6): 1247-53, 2013 Jun.
Article
em En
| MEDLINE
| ID: mdl-23583166
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 OUTCOMEMEASURES:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Programas de Rastreamento
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Cuidados de Saúde não Remunerados
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Dedutíveis e Cosseguros
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Retinopatia Diabética
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article