Diabetic retinopathy service delivery and integration into the health system in Pakistan—Findings from a multicentre qualitative study

Abstract

This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments’ priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.

Nuclear proteins and diabetic retinopathy: a review

“…This prevalence was reduced bynutritional, social, and medical support, and these factors also slow the progression of DR. This suggests that working on environmental factors may help to reduce the prevalence of DR in diabetics [ 43 ].…”

Exploring the protective effects of herbal monomers against diabetic retinopathy based on the regulation of autophagy and apoptosis: A review

“…[ 1 ] The incidence of diabetic macular edema and/or proliferative DR may lead to blindness in diabetic patients. [ 2 ] It is estimated that 700 million people worldwide will suffer from diabetes in 2045, and 35% of diabetes patients will suffer from diabetes retinopathy. [ 3 , 4 ] DR also leads to life-threatening vascular complications in the organism.…”