Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-Risk Population

Fairless, Elizabeth; Nwanyanwu, Kristen

doi:10.1007/s40615-019-00627-3

Cited by 37 publications

(21 citation statements)

References 25 publications

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“…12 However, a study at a community health center showed that diabetic patients were less likely to seek eye care unless they noticed symptomatic changes in their vision. 13 Similarly, our data demonstrated that patients with worse vision, DME, and greater NPDR severity were more likely to follow-up. A worsening vision and presence of DME were also independent predictors of increased follow-up adherence.…”

Section: Multivariate Analysissupporting

confidence: 70%

Follow-Up Adherence in Patients With Nonproliferative Diabetic Retinopathy Presenting to an Ophthalmic Emergency Department

Watane¹,

Kalavar²,

Vanner³

et al. 2021

Retina

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To determine the rate of follow-up after emergent encounters for nonproliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up adherence.Methods: A retrospective cohort study of patients presenting to an ophthalmic emergency department with nonproliferative diabetic retinopathy between May 2014 and December 2018 was conducted. Demographic and encounter data were gathered. Adherence to follow-up was defined as a completed encounter within 5 weeks of the recommended follow-up.Results: A total of 1,248 patients were included. The overall follow-up rate was 53%. Significantly decreased odds of follow-up adherence were associated with longer physician recommended follow-up intervals (odds ratio: 0.81, P , 0.001), longer interval to scheduled appointment (OR: 0.98, P , 0.001), commercial insurance (OR: 0.76, P = 0.01), and lack of any insurance (OR: 0.57, P , 0.01). Significantly increased odds were associated with a longer emergency department visit duration (OR: 1.002, P = 0.001), farther home distance (1.02, P , 0.01), increased likelihood of living in a higher income area (OR: 1.07, P = 0.04),

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Section: Multivariate Analysissupporting

confidence: 70%

Follow-Up Adherence in Patients With Nonproliferative Diabetic Retinopathy Presenting to an Ophthalmic Emergency Department

Watane¹,

Kalavar²,

Vanner³

et al. 2021

Retina

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“…Better training, transparent organizational structure, and clear bidirectional communication may address these concerns. Fostering a culture which regularly seeks feedback and acts upon it is especially important to successful implementation; feeling heard and empowered is critical to buy-in [ 45 – 47 ]. Although likely situational, others may still learn from the description of hostile sentiments towards TECS occupants of CBOC space for future planning.…”

Section: Discussionmentioning

confidence: 99%

Stakeholder perceptions affecting the implementation of teleophthalmology

Snider

Maa

Guyton

et al. 2022

BMC Health Serv Res

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Purpose Teleophthalmology has become the subject of heightened interest and scrutiny in the wake of the SARS-CoV-2 global pandemic. A streamlined implementation framework becomes increasingly important as demand grows. This study identified obstacles to teleophthalmology implementation through summative content analysis of key stakeholders’ perceptions. Design Summative content analysis of transcribed interviews with key stakeholders (including patients, technicians, ophthalmic readers, staff, nurses, and administrators at two teleophthalmology clinic sites). Methods Keyword Were counted and compared to examine underlying meaning. Two analysts coded text independently using MAXQDA for summative qualitative content analysis to derive themes and hierarchical relationships as a basis for future refinement of TECS implementation. xMind ZEN was used to map conceptual relationships and overarching themes that emerged to identify perceived facilitators and barriers to implementation Results Analysis revealed two themes common to perceptions: (1) benefits of care, and (2) ease of implementation. Perceived benefits included efficiency, accessibility, and earlier intervention in disease course. The quality and quantity of training was heavily weighted in its influence on stakeholders’ commitment to and confidence in the program, as were transparent organizational structure, clear bidirectional communication, and the availability of support staff. Conclusion Using a determinant framework of implementation science, this report highlighted potential hindrances to teleophthalmology implementation and offered solutions in order to increase access to screening, improve the quality of care provided, and facilitate sustainability of the innovation.

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“…The present study fits in the international context as an existing theoretical framework [ 50 , 51 ] was adopted to inform the interview topics guide and qualitative data analysis. Although findings from this study were specific to the Australian health system, several lessons can be drawn that can enrich the current literature.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to diabetic retinopathy screening within Australian primary care

et al. 2021

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Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.

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Barriers to and Facilitators of Diabetic Retinopathy Screening Utilization in a High-Risk Population

Cited by 37 publications

References 25 publications

Follow-Up Adherence in Patients With Nonproliferative Diabetic Retinopathy Presenting to an Ophthalmic Emergency Department

Follow-Up Adherence in Patients With Nonproliferative Diabetic Retinopathy Presenting to an Ophthalmic Emergency Department

Stakeholder perceptions affecting the implementation of teleophthalmology

Barriers and facilitators to diabetic retinopathy screening within Australian primary care

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