Influence of primary care practices on patients’ uptake of diabetic retinopathy screening: a qualitative case study

Abstract

BackgroundThe NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes in England by enabling prompt diagnosis of sight-threatening retinopathy. However, the rate of screening uptake between practices can vary from 55% to 95%. Existing research focuses on the impact of patient demographics but little is known about GP practice-related factors that can make a difference.AimTo identify factors contributing to high or low patient uptake of retinopathy screening.Design and settingQualitative case-based study; nine purposively selected GP practices (deprived/affluent; high/low screening uptake) in three retinopathy screening programme areas.MethodsSemi-structured interviews were conducted with patients, primary care professionals, and screeners. A comparative case-based analysis was carried out to identify factors related to high or low screening uptake.ResultsEight possible factors that influenced uptake were identified. Five modifiable factors related to service and staff interactions: communication with screening services; contacting patients; integration of screening with other care; focus on the newly diagnosed; and perception of non-attenders. Three factors were non-modifiable challenges related to practice location: level of deprivation; diversity of ethnicities and languages; and transport and access. All practices adopted strategies to improve uptake, but the presence of two or more major barriers made it very hard for practices to achieve higher uptake levels.ConclusionsA range of service-level opportunities to improve screening attendance were identified that are available to practices and screening teams. More research is needed into the complex interfaces of care that make up retinopathy screening.

Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature

“…holidays, religious/cultural activities. One HCP commented that: ‘ People go away…to the Caribbean, Africa, Asia, Pakistan, India… and because they're away they're not going to get their screening done ’ .…”

“…In some countries, people with diabetes were not referred because there was no available eye doctor [14]. Inaccurate or incomplete registers could also result in lack of referral [15,18]. Theme: Specialist diabetes services and staff (six studies).…”

Individualised variable-interval risk-based screening for sight-threatening diabetic retinopathy: the Liverpool Risk Calculation Engine

“…Screening at 3-yearly intervals has been introduced in Sweden, based on data from one programme [10], and is supported as being cost-effective in a recent UK modelling study [11]. However, concerns about the safety and acceptability of extended intervals have held back adoption [12,13].…”

Health checks and screening: what works in general practice?

“…In terms of case finding, Koekkoek et al 5 draw attention to the greater effectiveness of stepped screening programmes, with the first step being identification of patients most likely to benefit from a resourceintensive face-to-face appointment. They also echo Lindemeyer et al 14 Lindemeyer et al 14 give a practical example. One important reason for diabetic case finding is that blindness from microvascular complications is preventable.…”