A retrieval system for patients with avoidable blindness due to diabetic retinopathy who do not present for ophthalmic assessment in Oman

Abstract

Background:Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters (patients who do not present or “no-show”) with Sight Threatening Diabetic Retinopathy (STDR). We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009.Materials and Methods:Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy (DR) and medical retina specialists manage DR in Oman. A person with proliferative stage of DR (PDR) and/or Diabetic Macular Edema (DME) in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital.Results:We registered 654 STDR cases, of which 494 (75%) were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 (66.4%) defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases (85%) had poor glycemic control.Conclusion:Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus.

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

“…The quality appraisals of the included studies (n = 53 24,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][163][164][165][166][167][168][169][170][172][173][174][175][177][178][179][180]182,184,185,187,[190][191][192]194,195,197,199,[201][202][203][204][205][206][207][208]…”

“…On the basis of expressed importance, domains judged to be important in the included studies were 'environmental context and resources' (19 studies 148,152,154,155,158,160,161,166,170,179,[185][186][187]189,191,194,199,201,207 ), 'knowledge' (19 studies 152,[158][159][160][161]165,[167][168][169][173][174][175]181,190,191,193,195,200,205 ), 'memory, attention and decision processes' (11 studies 156,166,170,[179][180][181][182]187,189,193,…”

“…People with diabetes also expressed fear or anxiety about the screening procedure 157,188,204 and some feared a medical intervention if they were confronted with a diagnosis. 148,191 Interestingly, one study reported that non-adherent people expressed less concern about losing their vision than adherent people. 192 Theme: defensive responses…”

Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy

“…[18][19][20] A variety of factors contributed to the high noncompliance rate, such as transport, absence of a decision maker, fear of laser treatment, socioeconomic barriers, health system barriers, educational barriers, and cultural barriers. [21][22][23] According to our clinical experience, the same issues occurred in Chinese patients with diabetes, but the underlying factors were unclear. Moreover, many patients defaulted from the laser treatment in progress, although many reports showed that the supplementary laser photocoagulation and the subsequent follow-up were as important as the initial laser sessions.…”

Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

“…Studies of DR services in Pakistan, Oman and China reported that 29.5%, 22.8% and 27.9% of patients respectively did not initiate treatment. [7][8][9] In the study in China, an additional 17.6 % did not complete the treatment course, for reasons including being unaware of the importance of treatment and the need to complete the full course, and fear of treatment. 9 In high-income countries the proportion of patients not completing treatment tends to be lower than in low-income countries but still significant.…”