Mental health issues, other barriers drive diabetic retinopathy screening nonattendance
Key takeaways:
- Mental health issues and lack of awareness about diabetic eye screening were leading factors that led to nonattendance.
- Interventions such as telephone prompts and text message reminders may improve uptake.
Mental health issues, lack of awareness, transportation difficulties and other factors contributed to diabetic retinopathy screening nonattendance among patients with diabetes, according to a study published in Cureus.
“In the initial stages of non-proliferative diabetic retinopathy, most patients do not notice any visual changes, as these can take years to develop,” Upamanyu Leo Chanda, MBBS, of New Cross Hospital in Wolverhampton, England, and colleagues wrote. “Regular attendance at diabetic eye screening is therefore vital to identify potentially sight-threatening diabetic retinal changes and slow the progression of diabetic retinopathy.”
To assess adherence to National Institute for Health and Care Excellence guidelines for diabetic retinopathy screening and identify factors influencing nonattendance, Chanda and colleagues conducted a single-center retrospective clinical audit at a medium-sized general practice in the U.K. with approximately 9,000 patients.
The researchers utilized the SystmOne patient database, an electronic health record system, to identify 602 patients in the diabetes register who did not attend diabetic eye screening in the last 15 and 36 months prior to Sept. 28, 2022. Individuals who did not attend diabetic eye screening for a period of three or more annual cycles were categorized as repeat nonattenders by Public Health England diabetic eye screening guidelines.
Overall, 137 patients (mean age, 60.6 years; 58.4% men) in the diabetes register did not attend diabetic eye screening within the last 15 months (77.2% uptake), and 99 did not attend within the last 36 months (83.6% uptake). These results showed uptake exceeded the 75% screening target, according to the researchers.
Next, the researchers administered a survey to every third patient who missed screening in the last 15 months (n = 21) to identify reasons for nonattendance.
The survey revealed that the most common reason for nonattendance to diabetic eye screening appointments was mental health issues (n = 7), such as depression, anxiety and paranoia.
Other reasons for nonattendance included multifactorial (n = 4), lack of awareness about diabetic eye screening (n = 3), transport difficulties (n = 2), not receiving the reminder letter (n = 2), illness (n = 2) and forgetfulness (n = 1).
The researchers proposed several interventions to increase attendance to diabetic eye screening, including telephone prompts, text message reminders and the implementation of an online patient education system for all individuals in the diabetes register.
“Despite achieving a higher diabetic eye screening uptake than the minimum target set by the National Health Service Diabetic Eye Screening Program, this audit emphasizes the need for continuous efforts to raise awareness and support patients in attending regular screening,” the researchers wrote. “Future re-audits following the implementation of the proposed interventions could help evaluate the impact of these strategies and provide further insights into optimizing diabetic retinopathy screening in primary care.”
Chanda and colleagues acknowledged several study limitations, including its small sample size and the subjective nature of the questionnaire, which prevented individuals from being able to list every reason for nonattendance.
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