Divergent Perceptions of Barriers to Diabetic Retinopathy Screening Among Patients and Care Providers, Los Angeles, California, 2014–2015

Abstract

IntroductionDespite availability of screening for diabetic retinopathy, testing is underused by many low-income and racial/ethnic minority patients with diabetes. We examined perceived barriers to diabetic retinopathy screening among low-income patients and their health care providers and provider staffers.MethodsWe collected survey data from 101 patients with diabetes and 44 providers and staffers at a safety-net clinic where annual diabetic retinopathy screening rates were low. Barriers specified in the survey were derived from the literature.ResultsPatients surveyed (mean [standard deviation] age, 54.0 [7.7] y; 41% were male) were primarily Hispanics (70%) and African Americans (27%) of low socioeconomic status. Overall, 55% of patients received diabetic retinopathy screening in the previous year. Patients who could not explain why this screening is needed reported more barriers than patients who could (2.5 vs 1.4 barriers, P = .02). Fewer patients reported that they experienced barriers such as transportation (15%), language issues (15%), cultural beliefs or myths (4%), denial (8%), and fear (5%), which providers and staffers considered very or extremely important (all P < .001). Financial burdens (26%) and depression (22%) were most commonly reported by patients as barriers, yet providers and staffers did not rate these barriers as important, P < .001. ConclusionPatients and health care providers had markedly divergent perceptions of barriers to diabetic retinopathy screening. Patients with poor understanding of the need for screening were more likely to report such barriers. These results suggest a need for active community engagement to find key elements for education programs and other interventions to increase rates of diabetic retinopathy screening, particularly among low-income, minority populations.

The effectiveness of an obstructive sleep apnea screening and treatment program in patients with type 2 diabetes

“…28, 29 Some parallels can be drawn to universal diabetic retinopathy screening which only occurs in 49 to 56% of patients, with rates lower among those with lower income and racial and ethnic minorities as well as patients who poorly understood the rationale for screening. 30, 31 Further research to identify and overcome barriers to OSA screening will be necessary to implement more widespread testing.…”

Fundamental principles of an effective diabetic retinopathy screening program

“…Therefore, screening for DR should be done promptly after diagnosis and at regular risk-based intervals thereafter. Numerous factors are known to affect attendance at DR screening [87][88][89][90][91]. In an established mobile retinal screening service in Scotland, poor attendance at screening was not linked to gender or to distance from the event, but was associated with younger age, longer duration of diabetes, smoking, social deprivation, and poor HbA1c and blood pressure control; the highest proportion of non-attenders were in urban areas [92].…”

“…In a US study of low-income patients and their healthcare providers and staffers, investigators found a striking lack of agreement in perceived barriers to screening [90]. Providers and staffers felt that transportation, language issues, cultural beliefs or myths, denial and fear were key barriers to DR screening, whereas patients indicated that financial burden and depression were the most common barriers [90]. Judah et al [94] evaluated the effectiveness of financially incentivizing screening among patients in the NHS Diabetic Eye Screening Programme who had not attended an appointment for at least 2 years.…”

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

“…26 More recent community based studies also report poor rates of screening and monitoring, 27 especially in low income areas and in ethnic minorities, 28 particularly if patients do not understand the need despite availability of services. 29 Effective screening and follow-up are needed to detect retinal changes quickly and accurately, and this should be coupled with education for patients that highlights the need for screening.…”

“…Overweight Diabetics With Surgery or Best Medicine (PROMISE) is a multicenter RCT that aims to recruit 100 patients with type 2 diabetes, increased weight (body mass index [28][29][30][31][32][33][34][35] and impaired renal function (estimated GFR 30-60 mL/min/1.73 m 2 and albuminuria). 149 All patients will receive optimal medical treatment, and 50 will be randomly assigned to gastric bypass surgery (this would be outside current standard body mass index criteria for surgery).…”