Patient non-attendance at Diabetes-related Retinopathy screening

Patient non-attendance at Diabetes-related 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.[29] 

A recent systematic review [30] 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 (summarised 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

With all of this in mind, the ERN-EYE created a video to explain how we can support, comfort and welcome patients in a hospital environment. This video clip describes how to interact and communicate with people living with visual impairments so as to relax them before their appointment and encourage them to attend future appointments to take care of their eyes. Helpful tips include assisting people to their appointment, adjusting lighting as necessary and avoid moving their belongings, so as not to confuse and upset them. The full video is available to watch here.