Present status of ophthalmological care for diabetic patients in Japan

A Survey on the Current Status of Ophthalmological Consultations in Patients With Diabetes Undergoing Maintenance Hemodialysis and the Effectiveness of Education on Consultation Behavior –Experience of a Single Hemodialysis Clinic in Japan

Introduction

It is extremely important for patients with diabetes undergoing maintenance hemodialysis (MHD) to receive regular ophthalmologic examinations. However, even in the field of MHD in Japan, where there are many hemodialysis patients and the survival rate is said to be one of the highest in the world, we often see patients with diabetes who do not receive regular ophthalmologic examinations. In this study, we surveyed the status of ophthalmology consultations and the use of diabetic eye notebook (DEN) among hemodialysis patients with diabetes at hemodialysis clinics to confirm the current situation, with the aim of confirming the effectiveness of education on consultation behavior by medical care staff.

Materials and Methods

This study included 38 diabetic hemodialysis patients attending one MHD clinic in Japan for one year from March 2018 to March 2019. In the first fact-finding survey in March 2018, hemodialysis care unit nurses (HCUNs) in the hemodialysis unit asked the diabetic hemodialysis patients whether they had consulted an ophthalmologist and used the DEN. Based on the results, the HCUNs recommended that hemodialysis patients with complications of diabetes be educated about the usefulness of regular ophthalmologic examinations, even during MHD, and that they use the DEN. This was followed by a second fact-finding survey in March 2019 to reconfirm ophthalmology consultations and DEN use.

Results

Regarding the presence of ophthalmology consultations, 22 of 38 (58%) patients had regular ophthalmology consultations in March 2018, and 27 of 38 (71%) patients had consultations in the following year after receiving information from an HCUN. Only 1 of 22 patients (5%) who consulted the ophthalmologist in March 2018 used a DEN, but 19 of 27 patients (70%) used it the following year.

Conclusion

In the future, the development and utilization of a new DEN that includes more detailed patient information, and the spread of self-care guidance to patients by multidisciplinary health care professionals, will increase the consultation rate of MHD patients in Japan and reduce the incidence and progression of ocular diseases in MHD patients.

Evaluation of the Total Design Method in a survey of Japanese dentists

BACKGROUND

This study assessed the application of the Total Design Method (TDM) in a mail survey of Japanese dentists. The TDM was chosen because survey response rates in Japan are unacceptably low and the TDM had previously been used in a general population survey.

METHODS

Four hundred and seventy eight dentist members of the Okayama Medical and Dental Practitioner's Association were surveyed. The nine-page, 27-item questionnaire covered dentist job satisfaction, physical practice, and dentist and patient characteristics. Respondents to the first mailing or the one-week follow-up postcard were defined as early responders; others who responded were late responders. Responder bias was assessed by examining age, gender and training.

RESULTS

The overall response rate was 46.7% (223/478). The response rates by follow-up mailing were, 18% after the first mailing, 35.4% after the follow-up postcard, 42.3% after the second mailing, and 46.7% after the third mailing. Respondents did not differ from non-respondents in age or gender, nor were there differences between early and late responders.

CONCLUSION

The application of TDM in this survey of Japanese dentists produced lower rates of response than expected from previous Japanese and US studies.

Questionnaire survey on periodic ocular examination in Japanese diabetic patients

PURPOSE

To identify the reasons why diabetic patients do not undergo periodic examination.

DESIGN

Cohort study.

METHODS

A questionnaire survey of 1,333 Japanese type 2 diabetic patients was conducted at Tokyo Women's Medical University. Performance of ocular examinations was investigated over 5 years and the reasons for not undergoing examination were analyzed.

RESULTS

Periodic ocular examination was performed in 69.5% of patients, but not in 30.5%. The questionnaire survey showed that physicians usually explained the risk of ocular complications and recommended periodic examination. More than 98% of the patients were aware of diabetic eye disease. Multivariate logistic regression analysis showed the main reason for skipping examination as a reason was that patients believed they had no diabetic retinopathy.

CONCLUSIONS

Patients should be informed about the necessity of receiving periodic ocular examination even if they do not yet have retinopathy.