Patient non-attendance at Diabetes-related Retinopathy screening

Patient non-attendance at Diabetic Retinopathy screening

In those countries that have implemented systematic retinal screening for all people with diabetes, non-attendance at screening appointments continues to be a major challenge. For example, in the United Kingdom, it has been reported that as many as 1 in 5 people with diabetes fail to attend screening appointments.[33] 

A recent systematic review[34] of published studies evaluating the reasons for non-attendance at diabetes-related screening appointments in the UK and several other countries (Saudi Arabia, USA, Ireland, Iceland, The Netherlands) identified a number of patient- and health system-specific reasons why patients may not attend the diabetes-related eye screening appointment (summarized below):

Patient level factors:

  • Lack of awareness about Diabetes-related Retinopathy and the fact it can lead to blindness
  • Anxiety about screening
  • Fear, particularly of laser treatment
  • Guilt, about glycemic stability causing retinopathy
  • Not engaging with any diabetes care
  • Being misinformed about screening
  • Having competing priorities
  • Socio-economic deprivation 

Health system-level factors may include:

  • Miscommunication about where the patient lives / their clinical situation
  • Not sending the screening invitations out on time
  • Patients’ clinical notes not being shared 

Some of these factors are modifiable, and the following strategies were suggested by the authors to improve attendance at Diabetes-related Retinopathy screening:

  • Improving communication between primary care physicians and screening services
  • Improving ways in which patients are invited and contacted for the screening
  • Ensuring screening is recommended by the physician
  • Making programmes sensitive to differences of ethnic minorities, and attempting to bridge the language barrier gap
  • Having screening sites in areas that are easily accessible with good transport links
  • Integrating retinal screening with other diabetes-related care