Analysis of reasons for noncompliance with laser treatment in patients of diabetic retinopathy

Abstract

Objective-To identify the underlying reasons for noncompliance among Chinese patients undergoing laser photocoagulation treatment for diabetic retinopathy (DR). Design-Prospective cohort study.Participants-A total of 262 patients with DR with indications for panretinal photocoagulation and focal laser treatment were recruited.Methods-Those who did not complete the prescribed laser treatment were categorized into 2 types of defaulters: Type 1 defaulters were those who did not initiate laser treatment as scheduled; type 2 defaulters were those who did not complete the entire laser sessions, including terminating midterm or defaulting prompt supplement of laser treatment. A standardized questionnaire was given to the 2 types of defaulters to collect information about the reasons for noncompliance. Data were analyzed and subjected to χ 2 test or Fisher exact statistical tests.Results-The noncompliance rate was 45.5%, which is significantly greater than some developed countries. Unawareness of the necessity for treatment and unawareness of the importance to complete treatment were 2 main reasons leading to noncompliance, representing 28.8% and 36.0%, respectively. Unawareness of the necessity for treatment and fear of laser treatment were more important for type 1 defaulters (29 vs 6 and 11 vs 0, respectively), whereas unawareness of completeness of laser treatment was overweighed in type 2 defaulters (27 vs 13 patients; all P < 0.01). These results were likely related to the lack of knowledge about the potential consequences of DR, the underlying principle of laser treatment, and panretinal photocoagulation procedures.Conclusions-Developing appropriate education programs targeting specific reasons will help to improve the compliance in patients with DR. The bulk of the evidence shows that prompt panretinal photocoagulation (PRP) and focal (direct or grid) laser treatment reduced the risk for severe visual loss compared with deferral of treatment over the long term. [12][13][14][15][16][17] Several studies in the United States have shown that many patients with diabetes fail to seek or receive dilated eye examination and timely treatment according to guidelines, and the average compliance rate may vary from approximately 30% to 60%. 18-20 A variety of factors contributed to the high noncompliance rate, such as transport, absence of a decision maker, fear of laser treatment, socioeconomic barriers, health system barriers, educational barriers, and cultural barriers. [21][22][23] According to our clinical experience, the same issues occurred in Chinese patients with diabetes, but the underlying factors were unclear. Moreover, many patients defaulted from the laser treatment in progress, although many reports showed that the supplementary laser photocoagulation and the subsequent follow-up were as important as the initial laser sessions. [24][25][26] The literature shows the value of educational programs in improving patient adherence to guidelines when the programs targeted specific reasons behind the noncompli...

Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

“…Studies of DR services in Pakistan, Oman and China reported that 29.5%, 22.8% and 27.9% of patients respectively did not initiate treatment. [7][8][9] In the study in China, an additional 17.6 % did not complete the treatment course, for reasons including being unaware of the importance of treatment and the need to complete the full course, and fear of treatment. 9 In high-income countries the proportion of patients not completing treatment tends to be lower than in low-income countries but still signi cant.…”

“…[7][8][9] In the study in China, an additional 17.6 % did not complete the treatment course, for reasons including being unaware of the importance of treatment and the need to complete the full course, and fear of treatment. 9 In high-income countries the proportion of patients not completing treatment tends to be lower than in low-income countries but still signi cant. A review in the USA reported that approximately 15% of patients didn't initiate treatment and 15% of those didn't complete it.…”

Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?

“…In some communities with limited access to eye care, TMDRS is often the only chance for patients to be evaluated, and image quality requirements are higher. A few studies [15][16][17] have found low adherence to referral recommendations for ophthalmological care among patients discovered to have sight-threatening disease, regardless of availability and cost of treatment resources. Arguably, this finding would mean that patient engagement in future treatment and diabetes control needs to begin earlier, before severe retinal disease is present.…”

Effectiveness of interventions to increase uptake and completion of treatment for diabetic retinopathy in low- and middle-income countries: a rapid review protocol.

“…Studies of DR services in Pakistan, Oman and China reported that 29.5%, 22.8% and 27.9% of patients respectively did not initiate treatment. [7][8][9] In the study in China, an additional 17.6 % did not complete the treatment course, for reasons including being unaware of the importance of treatment and the need to complete the full course, and fear of treatment. 9 In high-income countries the proportion of patients not completing treatment tends to be lower than in low-income countries but still significant.…”

“…[7][8][9] In the study in China, an additional 17.6 % did not complete the treatment course, for reasons including being unaware of the importance of treatment and the need to complete the full course, and fear of treatment. 9 In high-income countries the proportion of patients not completing treatment tends to be lower than in low-income countries but still significant. A review in the USA reported that approximately 15% of patients didn't initiate treatment and 15% of those didn't complete it.…”