scholarly journals Diabetic Retinopathy Screening Programme: Attendance, Barriers and Enablers amongst Young People with Diabetes Mellitus Aged 12–26 Years

2021 ◽  
Vol 1 (3) ◽  
pp. 154-162
Author(s):  
Laura N. Cushley ◽  
Katie Curran ◽  
Nicola B. Quinn ◽  
Aaron Bell ◽  
Alyson Muldrew ◽  
...  
Keyword(s):  
Young People ◽  
Screening Programme ◽  
Diabetes Duration ◽  
Diabetes Clinic ◽  
Diabetic Retinopathy Screening ◽  
Barriers And Enablers ◽  
Eye Screening ◽  
One Stop ◽  
Diabetic Eye Screening ◽  
The Impact

The study aim is to investigate characteristics, barriers and enablers for attendance at the Diabetic Eye Screening Programme Northern Ireland (DESPNI) among people with diabetes aged 12–26 years. A mixed-methods approach with retrospective analysis and prospective, questionnaire-based data collection was completed. Data were analysed using ordinal logistic regression. A questionnaire collected information on barriers and enablers to attending DESPNI. Age, diabetes duration, attendance at diabetes clinic and lower HbA1c values were significantly associated with better attendance. Those aged 12–15 were more likely to attend screening than 16–26 years, odds ratio (OR) 4.01. Subjects diagnosed less than 5 years were more likely to attend than those with longer diabetes duration (OR = 2.52, p =< 0.001). Subjects who attended diabetes clinics were more likely to attend screening (OR = 1.89, p =< 0.001) and have a lower HbA1c (OR = 1.46, p =< 0.001). Questionnaires revealed major barriers to attendance which included inconvenient appointment times, lack of access and poor communication. While many subjects were aware of the impact of diabetes on the eye, many had little understanding of screening. This study provides pivotal information on potential barriers and enablers for young people attending eye screening. We suggest modest changes such as convenient appointment times, clearer communication and one-stop clinics could improve attendance.

scholarly journals Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?

2016 ◽  
Vol 11 (1) ◽  
pp. 135-137 ◽  
Author(s):  
Jorge Cuadros ◽  
George Bresnick
Keyword(s):  
Clinical Trials ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Low Cost ◽  
Clinical Results ◽  
Diabetic Retinopathy Screening ◽  
The United Kingdom ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

Organizations that care for people with diabetes have increasingly adopted telemedicine-based diabetic retinopathy screening (TMDRS) as a way to increase adherence to recommended retinal exams. Recently, handheld retinal cameras have emerged as a low-cost, lightweight alternative to traditional bulky tabletop retinal cameras. Few published clinical trials have been performed on handheld retinal cameras. Peer-reviewed articles about commercially available handheld retinal cameras have concluded that they are a usable alternative for TMDRS, however, the clinical results presented in these articles do not meet criteria published by the United Kingdom Diabetic Eye Screening Programme and the American Academy of Ophthalmology. The future will likely remedy the shortcomings of currently available handheld retinal cameras, and will create more opportunities for preventing diabetic blindness.

scholarly journals Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

2021 ◽  
Vol 9 (2) ◽  
pp. e002436
Author(s):  
Louise Prothero ◽  
Fabianna Lorencatto ◽  
Martin Cartwright ◽  
Jennifer M Burr ◽  
Philip Gardner ◽  
...  
Keyword(s):  
Young Adults ◽  
Screening Programme ◽  
Perceived Barriers ◽  
Self Management ◽  
Screening Uptake ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
The Uk ◽  
Retinopathy Screening

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population.Research design and methodsMembers of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS.ResultsIn total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services.ConclusionsScreening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management.

scholarly journals Diagnostic accuracy of diabetic retinopathy grading by an artificial intelligence-enabled algorithm compared with a human standard for wide-field true-colour confocal scanning and standard digital retinal images

2020 ◽  
pp. bjophthalmol-2019-315394
Author(s):  
Abraham Olvera-Barrios ◽  
Tjebo FC Heeren ◽  
Konstantinos Balaskas ◽  
Ryan Chambers ◽  
Louis Bolter ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Proliferative Retinopathy ◽  
Retinal Images ◽  
Wide Field ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Confocal Scanning ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

BackgroundPhotographic diabetic retinopathy screening requires labour-intensive grading of retinal images by humans. Automated retinal image analysis software (ARIAS) could provide an alternative to human grading. We compare the performance of an ARIAS using true-colour, wide-field confocal scanning images and standard fundus images in the English National Diabetic Eye Screening Programme (NDESP) against human grading.MethodsCross-sectional study with consecutive recruitment of patients attending annual diabetic eye screening. Imaging with mydriasis was performed (two-field protocol) with the EIDON platform (CenterVue, Padua, Italy) and standard NDESP cameras. Human grading was carried out according to NDESP protocol. Images were processed by EyeArt V.2.1.0 (Eyenuk Inc, Woodland Hills, California). The reference standard for analysis was the human grade of standard NDESP images.ResultsWe included 1257 patients. Sensitivity estimates for retinopathy grades were: EIDON images; 92.27% (95% CI: 88.43% to 94.69%) for any retinopathy, 99% (95% CI: 95.35% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. For NDESP images: 92.26% (95% CI: 88.37% to 94.69%) for any retinopathy, 100% (95% CI: 99.53% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. One case of vision-threatening retinopathy (R1M1) was missed by the EyeArt when analysing the EIDON images, but identified by the human graders. The EyeArt identified all cases of vision-threatening retinopathy in the standard images.ConclusionEyeArt identified diabetic retinopathy in EIDON images with similar sensitivity to standard images in a large-scale screening programme, exceeding the sensitivity threshold recommended for a screening test. Further work to optimise the identification of ‘no retinopathy’ and to understand the differential lesion detection in the two imaging systems would enhance the use of these two innovative technologies in a diabetic retinopathy screening setting.

How parents and children view the system

2020 ◽  
pp. 43-64
Author(s):  
Clive Diaz
Keyword(s):  
Decision Making ◽  
Young People ◽  
Social Workers ◽  
Child Protection ◽  
High Turnover ◽  
Children And Young People ◽  
Barriers And Enablers ◽  
Parents And Children ◽  
System P ◽  
The Impact

This chapter considers children and parent’s perspectives of child protection conferences and whether they feel actively involved in decision making. It is based on interviews with 40 children and 52 parents in two local authorities whose children were subject to a child protection plan at the time. Most parents felt unsupported throughout the child protection process, reporting feelings of powerlessness, intimidation and fear. Parents reported that they found child protection conference particularly stigmatizing and oppressive and this led to them not trusting social workers and often other key agencies. A further interesting finding was that some parents felt sorry for their social workers and stated that they seemed stressed, clearly under too much pressure and often did not do what that said they could do. The chapter also considered young people’s views of social workers and what the barriers and enablers of good child protection practice are. This chapter highlights the high number of social workers young participants had; their relationships with their social worker and their perception of the child protection conference. The extent to which the young participants were aware of the impact of bureaucracy and high caseloads on the service they receive, coupled with the impact of the high turnover of social workers, was also examined. These factors impacted on how much the children and young people participated in the work that social workers were carrying out with them and the extent to which they trusted their social workers.

scholarly journals Implementation for Sustained Impact in Teleophthalmology (I-SITE): applying the NIATx Model for tailored implementation of diabetic retinopathy screening in primary care

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Alejandra Torres Diaz ◽  
Loren J. Lock ◽  
Todd D. Molfenter ◽  
Jane E. Mahoney ◽  
Deanne Boss ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Strategies ◽  
Local Context ◽  
Primary Care Clinics ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Implementation Program ◽  
The Us ◽  
Diabetic Eye Screening ◽  
Retinopathy Screening

Abstract Background Teleophthalmology provides evidence-based, telehealth diabetic retinopathy screening that is underused even when readily available in primary care clinics. There is an urgent need to increase teleophthalmology use in the US primary care clinics. In this study, we describe the development of a tailored teleophthalmology implementation program and report outcomes related to primary care provider (PCP) adoption. Methods We applied the 5 principles and 10 steps of the NIATx healthcare process improvement model to develop and test I-SITE (Implementation for Sustained Impact in Teleophthalmology) in a rural, the US multi-payer health system. This implementation program allows patients and clinical stakeholders to systematically tailor teleophthalmology implementation to their local context. We aligned I-SITE components and implementation strategies to an updated ERIC (Expert Recommendations for Implementing Change) framework. We compared teleophthalmology adoption between PCPs who did or did not participate in various components of I-SITE. We surveyed PCPs and clinical staff to identify the strategies they believed to have the highest impact on teleophthalmology use. Results To test I-SITE, we initiated a year-long series of 14 meetings with clinical stakeholders (n=22) and met quarterly with patient stakeholders (n=9) in 2017. Clinical and patient stakeholder groups had 90.9% and 88.9% participant retention at 1 year, respectively. The increase in teleophthalmology use was greater among PCPs participating in the I-SITE implementation team than among other PCPs (p < 0.006). The proportion of all PCPs who used the implementation strategy of electing diabetic eye screening for their annual performance-based financial incentive increased from 0% (n=0) at baseline to 56% (n=14) following I-SITE implementation (p = 0.004). PCPs and clinical staff reported the following implementation strategies as having the highest impact on teleophthalmology use: reminders to ask patients about diabetic eye screening during clinic visits, improving electronic health record (EHR) documentation, and patient outreach. Conclusions We applied the NIATx Model to develop and test a teleophthalmology implementation program for tailored integration into primary care clinics. The NIATx Model provides a systematic approach to engaging key stakeholders for tailoring implementation of evidence-based telehealth interventions into their local context.

scholarly journals Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial

2018 ◽  
Vol 102 (8) ◽  
pp. 1014-1020 ◽  
Author(s):  
Gaby Judah ◽  
Ara Darzi ◽  
Ivo Vlaev ◽  
Laura Gunn ◽  
Derek King ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Financial Incentives ◽  
Controlled Trial ◽  
Control Group ◽  
Attendance Rates ◽  
Incentive Group ◽  
Eye Screening ◽  
Diabetic Eye Screening ◽  
Randomised Controlled ◽  
The Impact

ObjectiveConflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders.Methods and analysisA three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons.Results34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group.ConclusionFinancial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

scholarly journals The contribution of the English NHS Diabetic Eye Screening Programme to reductions in diabetes-related blindness, comparisons within Europe, and future challenges

2021 ◽  
Vol 58 (4) ◽  
pp. 521-530
Author(s):  
Peter. H. Scanlon
Keyword(s):  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Disease Process ◽  
Diabetic Macular Oedema ◽  
Automated Analysis ◽  
Risk Groups ◽  
Pressure Control ◽  
Eye Screening ◽  
Future Challenges ◽  
Diabetic Eye Screening

AbstractThe aim of the English NHS Diabetic Eye Screening Programme (DESP) is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process, with a long-term aim of preventing blindness in people with diabetes.For the year 2009–2010, diabetic retinopathy (DR) was no longer the leading cause of blindness in the working age group. There have been further reductions in DR certifications for WHO severe vision impairment and blindness from 1,334 (5.5% of all certifications) in 2009/2010 to 840 (3.5% of all certifications) in 2018/2019. NHS DESP is a major contributor to this further reduction, but one must also take into account improvements in glycaemic and blood pressure control, timely laser treatment and vitrectomy surgery, improved monitoring techniques for glycaemic control, and vascular endothelial growth factor inhibitor injections for control of diabetic macular oedema. The latter have had a particular impact since first introduced in the UK in 2013.Current plans for NHS DESP include extension of screening intervals in low-risk groups and the introduction of optical coherence tomography as a second line of screening for those with screen positive maculopathy with two dimensional markers. Future challenges include the introduction of automated analysis for grading and new camera technologies.

Advanced diabetic eye disease

2020 ◽  
pp. 63-70
Author(s):  
Karen Whitehouse
Keyword(s):  
Diabetic Retinopathy ◽  
Subsequent Treatment ◽  
Eye Disease ◽  
Diabetic Retinopathy Screening ◽  
Eye Screening ◽  
Slow Progression ◽  
Long Time ◽  
Diabetic Eye Disease ◽  
Proliferative Disease ◽  
Diabetic Eye Screening

Advanced diabetic eye disease can remain asymptomatic for a long time, due to the slow progression of proliferative retinopathy and the fact that the macula may not be affected. This chapter examines the progression of proliferative disease and its’ natural history if left untreated. Diabetic retinopathy screening is an important factor in intervention and treatment. The grading criteria for advanced disease (R3) as defined by the NHS Diabetic Eye screening Programme (NHSDESP) is discussed, as well as the management of the patient and subsequent treatment regimen.

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