UK audit explores reasons patients skip diabetic retinopathy screenings

Addressing specific barriers can enhance screening rates, which may increase the detection of early retinopathy and improve patient outcomes. Image credit: ©Seventyfour – stock.adobe.com

A research team from England has identified factors, such as mental health issues, lack of diabetic eye screening awareness and transport difficulties, which interfere with attendance at annual screenings by patients with diabetes. The team also evaluated the adherence to guidelines set by the National Institute for Health and Care Excellence (NICE),¹ according to the lead author, Upamanyu Leo Chanda, MBBS. He is from the Emergency Department, New Cross Hospital, Royal Wolverhampton Trust, Wolverhampton, England.

The investigators underscored that diabetic retinopathy is the most common sight-threatening complication of diabetes that requires regular monitoring of eyes. NICE recommends annual diabetic eye screening for patients aged 12 and older.

In light of this, the investigators conducted a retrospective clinical audit to determine why patients do not adhere to the guidelines, comparing data from about 9,000 patients.

Study methods and findings

Chanda and colleagues used the SystmOne patient database to identify patients who had missed eye screening during the previous 15 and 36 months; those in the second group were considered non-attenders.

The investigators explained, “A survey of every third patient who missed screening in the last 15 months highlighted mental health issues, lack of diabetic eye screening (DES) awareness and transport difficulties as primary reasons for non-attendance. The DES uptake rates recorded at the practice were 77.2% (n=465) for the 15-month cohort and 83.6% (n=503) for the 36-month cohort, exceeding the NHS DES target of 75%.” The authors reported their findings in Cureus.

Having identified these factors, they proposed the following actions to increase attendance among patients to DES: “telephone prompts for patients with mental health concerns, text message reminders and online educational tools to improve uptake.”

Among the factors identified, the most prevalent reasons for non-attendance were linked to mental health issues and a lack of knowledge about diabetic retinopathy. The investigators suggested that implementing targeted interventions, such as phone call prompts for patients with known mental health conditions, text message reminders preceding appointments and online educational portals, should help increase the numbers of patients who attend annual screening examinations.

The investigators also pointed out the need for continuing these efforts to raise awareness and support patients in attending regular screening. “Future re-audits following the implementation of the proposed interventions could help evaluate the impact of these strategies and provide further insights into optimising diabetic retinopathy screening in primary care practices,” they said.

“Despite standards exceeding the national guidelines, this audit demonstrates the importance of addressing specific barriers to enhance screening rates, potentially increasing the detection of early retinopathy and improving patient outcomes,” Chanda and colleagues stated.

Reference

1. Chanda U, Madasu A, Bhardwaj A, et al. Barriers to yearly diabetic retinopathy screening attendance: a retrospective clinical audit. Cureus. 2024;16: e75474. doi:10.7759/cureus.75474; published online December 10, 2024.