Mental Health and Awareness Barriers Hinder Diabetic Eye Screenings

A research team from Great Britain has identified several key barriers that prevent patients with diabetes from attending annual diabetic eye screenings. These include mental health challenges, lack of awareness about diabetic eye screening (DES), and transportation difficulties. The study, led by Upamanyu Leo Chanda, MBBS, from the Emergency Department at New Cross Hospital, Royal Wolverhampton Trust, Wolverhampton, England, also evaluated adherence to the guidelines set by the National Institute for Health and Care Excellence (NICE).

Importance of Regular Diabetic Eye Screening

Diabetic retinopathy is the most common sight-threatening complication of diabetes, requiring regular eye monitoring. NICE recommends that patients aged 12 and older undergo annual diabetic eye screenings to ensure early detection and management of this condition.

Study Methods and Findings

The research team conducted a retrospective clinical audit involving approximately 9,000 patients in a primary care practice. Using the SystmOne patient database, they identified patients who had missed eye screenings in the previous 15 and 36 months. Those in the 36-month group were classified as non-attenders.

Key Results

       • DES uptake rates at the practice were:

               - 77.2% for the 15-month cohort.

               - 83.6% for the 36-month cohort.

       • Both rates exceeded the NHS DES target of 75%.

       • A survey of every third patient who missed screening in the past 15 months revealed the primary reasons for non-attendance:

               - Mental health issues.

               - Lack of awareness about DES.

               - Transportation challenges.

These findings were published in Cureus.

Proposed Interventions to Improve Screening Rates

To address these barriers, the investigators suggested several targeted interventions:

       1. Telephone prompts for patients with mental health concerns.

       2. Text message reminders for upcoming appointments.

       3. Online educational tools to raise awareness about diabetic retinopathy and the importance of screenings.

Addressing Mental Health and Awareness Gaps

Mental health issues and a lack of knowledge about diabetic retinopathy were identified as the most significant factors influencing non-attendance. Implementing these interventions is expected to improve DES attendance rates and enhance early detection of diabetic retinopathy.

Continuing Efforts and Future Strategies

The researchers emphasized the importance of ongoing efforts to increase awareness and support patients in attending regular screenings. They proposed conducting future re-audits to evaluate the effectiveness of these strategies and further optimize diabetic retinopathy screening practices in primary care.

Conclusion

The study highlights the critical need to address specific barriers to diabetic eye screening. While the practice exceeded the national guidelines for screening uptake, targeted interventions could further enhance attendance rates, enabling earlier detection of diabetic retinopathy and improving patient outcomes. As Chanda and colleagues stated, “This audit demonstrates the importance of addressing specific barriers to enhance screening rates, potentially increasing the detection of early retinopathy and improving patient outcomes.”

Reference:

Chanda U, Madasu A, Bhardwaj A, et al. Barriers to yearly diabetic retinopathy screening attendance: a retrospective clinical audit. Cureus. 2024;16: e75474. doi:10.7759/cureus.75474