Characteristics of repeat non‐attenders at Diabetes Eye Screening Wales, a national community‐based diabetes‐related retinopathy screening service, during 2003‐2018

Abstract

Aims To understand factors associated with repeat non‐attendance at screening for diabetes‐related retinopathy. Methods Retrospective observational study using anonymised data from Diabetic Eye Screening Wales for people with a full history of screening invitations and attendances was linked with primary and secondary care records held in the Secure Anonymised Information Linkage Databank. Repeat non‐attendance was defined as no record of attendance during any 36‐month period despite three cycles of annual screening invitations. The associations between repeat non‐attendance and potential risk factors were examined using multivariable logistic regression analysis, stratified according to type 1 and type 2 diabetes. Results A total of 18% with type 1 diabetes (1146/6513) and 8% with type 2 diabetes (12,475/156,525) were repeat non‐attenders. Participants attending their very first appointment were least likely to become repeat non‐attenders [odds ratio (95% confidence interval)]: type 1 diabetes: 0.12 (0.09, 0.17) and type 2 diabetes: 0.08 (0.07, 0.09). For both types of diabetes, those of a younger age, living in areas of higher deprivation and subject to multiple house moves were at greater risk of becoming repeat non‐attenders. Conclusion/interpretation A more tailored approach is needed for the younger population, those living in areas of higher deprivation and/or undergoing multiple residential relocation and to ensure attendance at their initial appointment to minimise future repeat non‐attendance.

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

“…A recent study of repeat non-attenders to the Welsh national screening program found that frequent house moves were associated with a failure to attend three consecutive annual screening appointments. 27 Residential moves between different geographic areas are more likely in the young adult population as they move for study or employment, which could be a contributing factor to suboptimal DRS attendance in this population. Although participants reported that they were limited in their ability to discuss diabetes self-management due to a lack of information on how attendees are managing their diabetes, approximately 90% of respondents indicated that they would like the ability to refer onwards for further support.…”

Focussing care

“…In a separate analysis of the Wales eye screening data, the characteristics of repeat non‐attenders to screening are reported 6 . The findings echo those in Liverpool with repeat non‐attenders most likely to live with type 1 diabetes, be younger, live in an area with greater deprivation and have multiple house moves.…”

Factors Associated With Nonattendance in a Nationwide Screening Program for Diabetic Retinopathy: A Register-Based Cohort Study

“…A recent systematic review identified environmental barriers, such as accessibility, time, and financial concerns, while individual-level barriers included absence of symptoms, lack of knowledge about the relevance of screening, and lack of support from family/friends (17). In addition, studies have reported that lower socioeconomic status, ethnicity, and poor glycemic control are associated with nonattendance in diabetic retinopathy screening (18)(19)(20)(21)(22). However, screening attendance could be prone to country-specific factors because screening programs, health systems, and environmental factors differ significantly from country to country.…”

“…However, a recent Irish study using national data found an overall nonattendance rate of 18.5% for all screening appointments over a 7-year period (20). In addition, a register-based study from Wales that measured nonattendance as failure to attend three consecutive annual screening appointments over a period of 36 months found a nonattendance rate of 8% among people with type 2 diabetes (19). Common for the screening procedures in both Ireland and Wales is the use of invitations with scheduled appointments as well as reminders to participate.…”