Interventions to increase attendance for diabetic retinopathy screening

Abstract

This is the published version of the paper.This version of the publication may differ from the final published version. Permanent repository link: T A B L E O F C O N T E N T S A B S T R A C TThis is the protocol for a review and there is no abstract. The objectives are as follows:The primary objective of the review is to assess the effectiveness of intervention components that seek to increase attendance for diabetic retinopathy screening in people with type 1 and type 2 diabetes. Secondary objectives:• To use validated taxonomies of QI intervention strategies and behaviour change techniques (BCTs) to code the description of interventions in the included studies and determine whether interventions that include particular QI strategies or component BCTs are more effective in increasing screening attendance;• To explore heterogeneity in effect size within and between studies to identify potential explanatory factors for variability in effect size;• To explore differential effects in subgroups to provide information on how equity of screening attendance could be improved;• To critically appraise and summarise current evidence on the resource use, costs and cost-effectiveness. There is limited evidence on the economic burden of diabetic retinopathy. One recent estimate for healthcare costs in Sweden was EUR 106,000 per 100,000 population per year based upon a prevalence of diabetes of 4.8% (95% confidence interval 4.7 to 4.9) (Heintz 2010). These costs exclude cost impacts on those with diabetic retinopathy and their families. Although effective treatments are available for sight-threatening diabetic retinopathy in the form of laser photocoagulation (Evans 2014) and more recently the use of anti-vascular endothelial growth factor inhibitors (Virgili 2014), the success of these interventions is dependent on early detection and timely referral for treatment. Diabetic retinopathy screening fulfils the World Health Organization (WHO) criteria for a screening programme (Scanlon 2008): namely, diabetes-associated visual impairment is an important public health problem; potentially sight-threatening retinopathy has a recognisable latent stage; a universally accepted and effective treatment is available; and screening has been shown to be cost-effective in terms of sight years preserved compared with no screening (Jones 2010). Annual or biennial diabetic retinopathy screening is recommended in many countries using a variety of screening modalities including: ophthalmoscopy performed by a number of healthcare professionals (including ophthalmologists, optometrists, diabetic physicians) or using standard retinal photography or digital fundus imaging (American Diabetes Association 2015; Kristinsson 1995; Scanlon 2008). However, relatively few countries have introduced a national population-based diabetic retinopathy screening programme and in most parts of the world screening remains non-systematic. The reference standard for the detection of diabetic retinopathy consists of seven standard 35-degree colour photographic fie...

Seeing Clearly: Effects of Initiatives to Improve Diabetic Retinopathy Screening at a Pediatric Center

“…A recent Cochrane review of 66 randomized, controlled trials in type 1 and type 2 diabetes demonstrated only a modest 12% increase in DRS attendance with QI strategies, consistent with our data and indicating how difficult it is to improve this metric ( 5 ). Patients at highest risk of diabetic retinopathy, including those with poor glycemic control, who have lower socioeconomic status, or who have diabetes complications such as microalbuminuria, have been demonstrated to be least likely to undergo DRS ( 3 , 6 ).…”

Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings

“…One review described interventions to promote DRS uptake [28]. In addition, there was another Cochrane review on quality improvement interventions to increase DRS attendance [29]. Another recently published review has also considered the barriers to access DRS without specifying the setting [30].…”

Knowledge and practices regarding diabetic retinopathy among diabetic patients registered in a chronic disease management system in eastern China

“…In our previous study, we used an in-depth interview method to explore the influencing factors on the compliance of timely visits among patients with proliferative diabetic retinopathy, and found that more than 90% of the patients were lacking knowledge about DR [12]. A recent Cochrane review showed that interventions to increase awareness about DR are vital in improving attendance for DR screening, and thus a potentially important solution for reducing blindness caused by DR [13]. Therefore, patient awareness and knowledge about DR will be the key to successful disease management and prevention.…”