Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model

Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider ( p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees ( p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees ( p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted ( p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.

Eye-care Utilization Among a Canadian Diabetic Refugee Population: A Retrospective Cohort Pilot Study

Background: Diabetic retinopathy (DR) is a leading and preventable cause of blindness. DR screening lies at the intersection of many documented challenges in access to care for refugees. Additionally, vision screening is determined to be an important health need and a critical locus for underutilization of health services among refugees resettling in Canada. To date, there is a limited body of evidence on the ocular health of refugees in Canada and no known studies on diabetic vision screening among refugees. Our objective was to identify patterns of eye-care utilization among refugee and non-refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL).Methods: We conducted a retrospective comparative cohort study at the Memorial University Family Medicine clinic, which includes the province’s largest dedicated refugee clinic. All patients with a new T2DM diagnosis between 2015-2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full approval from the Newfoundland and Labrador Health Research Ethics Board. Results: 73 (18 refugee, 55 non-refugee) patients were included. Refugees had a significantly higher rate of referral to an eye-care provider (ECP) (p=0.0475) and were more likely to attend their ECP appointment than non-refugees (p=0.016). The time from diagnosis to referral was significantly longer for refugees than non-refugees (p=0.0498). A trend towards a longer time from referral to appointment attendance for refugees than non-refugees was noted (p=0.9069). Conclusions: Our study is the first to report eye-care utilization among an Atlantic Canadian refugee population, and among the first to report access to diabetic vision care among refugees worldwide. Although refugee patients in our study cohort had higher rates of referral to ECPs and utilization of eye-care services, they also experienced a longer time to access care. Specialist care is known to be more challenging to access for vulnerable populations. Our findings suggest that there may be a role for ECPs to collaborate with primary care providers to improve access to vision screening services. Limitations include the small sample size as well as selection and detection bias inherent to a retrospective chart review.