Understanding the barriers to diabetic retinopathy services

Non-attendance at diabetic retinopathy (DR) screening or poor acceptance of treatment for diabetic eye disease has potentially serious clinical implications for people with diabetes and financial implications for DR programmes.

What do we mean by non attendance? Every screening service will have a list of people with diabetes who are invited for screening. Within this group, there will be people who do not take up their appointment during the screening period, for example over the last year for an annual screening programme. These people are considered as non attending.

The non attendance rate is calculated as the number not attending divided by the total number invited in that period multiplied by 100.

Case study: Reasons for non-attendance at screening

An established screening programme found its non attendance rate was 17% and undertook a study to determine the reasons why some people on their database were not attending screening. Interviews were conducted with patients who had attended screening and with patients who had stopped attending over the last 2 years or more or had never attended screening.

Some of their findings were:

• Regular attenders were highly motivated to attend for screening because they prioritised their general and eye health
• Those who had not attended for over two years had not prioritised their eye health, most frequently citing work related issues as the reason why
• Communication paths between health providers and patients who did not attend had broken down, for example due to incorrect or changes to address or phone number
• Almost all non-attenders did respond to a personal telephone call to arrange a screening appointment
• Several of the non-attenders needed immediate referral to ophthalmology due to their sight threatening diabetic retinopathy.

Challenges for acceptance of laser treatment

In addition to low attendance rates at screening, many studies have highlighted the challenges people with diabetes encounter in accepting laser treatment for their sight threatening diabetic retinopathy. Acceptance of laser treatment has been found to be as low as 21-45%, with many patients defaulting on their treatment plan.

In this video, we consider both the patient and provider factors that need to be identified and addressed in each local context to prevent blindness from DR. People with diabetes who miss screening appointments are often the most vulnerable and are likely to be at a higher risk of developing visual impairment.

As you watch the video, consider the ways DR programmes can motivate and support people with diabetes to attend screening over a long period of time.