Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation

Abstract

Background: Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals. Methods: We conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semistructured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCP from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening. Results: Thirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWD, referral into screening of PWD with diabetic changes regardless of planned interval. For PWD the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCP and PWD that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWD, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system.

Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT

“…Our parallel social science study demonstrated the acceptability of variable-interval, risk-based screening to individuals with diabetes and health professionals, provided that additional monitoring and fail-safe mechanisms are included [37]. Further evaluation should include the effect of factors such as the unexplained heterogeneity among screening programmes in England in terms of grading outcomes and screening uptake.…”

Is Dichotomization into Regular versus Irregular Dental Attenders Valid? A Qualitative Analysis

“…Patients’ understanding of the purposes of dental visiting and the links this has with dental visiting behaviors shows strong similarities with studies on preventive visiting in general medical care services. The concept of preventive visits as insurance, with the health care provider viewed as taking responsibility for maintaining health, has similarly been found in patients’ accounts of eye screening ( Byrne et al 2020 ). This may underlie in part patients’ preferences toward dental visits at standard, regular intervals compared with risk-based intervals ( Fee et al 2020 ).…”

“…This may underlie in part patients’ preferences toward dental visits at standard, regular intervals compared with risk-based intervals ( Fee et al 2020 ). The use of risk-based intervals between preventive visits rather than standardized intervals is contested by patients in various areas of preventive health care visits, due in part to worries about longer intervals not being sufficient for preventing disease, cynicism about cost-saving motives on the part of health care services rather than health promotion motives, and regular visits being seen as an important motivation for self-care maintenance ( He et al 2018 ; Byrne et al 2020 ).…”

Validation of an Algorithm for the Prediction of Diabetic Retinopathy in Type 1 Diabetic Patients in a Spanish Population

“…It was applied to 179 patients with T1DM, but their results did not report the cohort by type of DM, so we do not know if they were as effective in the case of patients with T1DM as in the rest of the sample, which included a total of 4538 patients with DM. 17 , 22 …”