Globally more than 366 million adults are living with diabetes and this will rise to over 522 million by 2030.¹ A complication of diabetes is that it can cause blindness due to changes in the blood vessels at the back of the eye (retinopathy). Diabetic retinopathy is the leading cause of blindness in working-age people in England and Wales. A national once-a-year screening programme can pick up the early signs of changes to these blood vessels and affected people can then be treated.
At the time of undertaking the audit, the researchers found that although uptake of diabetic retinopathy screening in Derbyshire was 73%, it did not reach the national gold standard of 80% and some specific population groups were not accessing the service. The study, published in the Journal of the Royal Society for Public Health, has several key findings:
• Younger people, particularly those with type 1 diabetes who are most at risk of going blind were more likely not to attend their appointments (over 3 times more likely).
• There was a lack of understanding about what 'retinopathy' is and why annual screening is important.
• Poorer people were more likely not to attend than more affluent people (20% less likely to attend if in the poorest area compared to the most affluent).
• Younger people liked the idea of online booking for appointments and text message reminders.
• People said that they didn't attend appointments because they forgot, couldn't get the time off work, didn't see it as a priority compared to other health or social issues, didn't realise it was important as it wasn't mentioned by the GP/practice nurse at the annual review or they had a clear screen last time and didn't think they needed to attend again.
Vital early detection
Leading the study, Dr Elizabeth Orton
, from the University’s Division of Primary Care
, said: “It is really important to go for eye screening every year if you have diabetes as it can save your vision. Even if you don't think that your eyes have been affected they might have been, especially if you have had diabetes for a long time. The longer you have diabetes the higher the chance of having problems with your sight and screening can detect this early and you can have treatment.
“The NHS eye screening services locally need to provide screening services that are accessible to young and working age people with diabetes so that they can attend appointments, for instance, out of hours clinics and clinics in that are located in easy-access place, minimising the cost of attending an appointment. Also, screening services should engage new technologies for people to make appointments and be reminded of them, for example, online booking and phone messaging. GPs and practice nurses need to encourage their patients to attend eye screening appointments at the annual diabetes review.”
The new service commissioner, NHS England Nottingham /Derbyshire Area Team note that the research is already having a positive impact in Derbyshire. Uptake has risen to 74.5% and efforts to support the four GP practices with the highest rates of non-attendance is making a difference. Commissioners and providers are continuing to work together to make changes which include:
• Using the phrase ‘diabetic eye disease’ rather than ‘retinopathy’.
• Contacting patients by post when they fail to attend rather than delay until the next health check.
• Establishing a direct line between practices to the screening booking team to facilitate bookings for ‘hard to engage’ individuals when actually in the practice.
• Developing online patient access booking and text reminder service to increase accessibility to male and younger cohorts.
• Maintaining the availability of out of hours screening provision and agreement to provide ad hoc sessions as necessary for working-age patients and delivering best practice workshops for GP administrative and clinical staff.
1. Woodman J, Brandon M, Bailey S, Belderson P, Sidebotham P, Gilbert R. Healthcare use by children fatally or seriously harmed by child maltreatment: analysis of a national case series. Arch Dis Child 2005e2007;96(3):270e5.
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