UCC researchers pilot a promising approach in general practice to encourage people to participate in diabetic retinopathy screening

Researchers from the School of Public Health, University College Cork have piloted an approach to encourage people to participate in Diabetic RetinaScreen, the national diabetic retinopathy screening programme in Ireland.


In a new study published in BMJ Open this month, the researchers examined whether it was feasible for staff in general practices to identify and remind their patients about Diabetes RetinaScreen, and whether the new approach was acceptable for staff and people with diabetes. They also wanted to see if  this approach was practical and made a difference in terms of screening attendance.


Diabetes can cause damage to blood vessels at the back of the eye which affects sight, a complication called retinopathy. It is very important to attend diabetic retinopathy screening regularly, as this increases the chance of damage to the eye being picked up early and treated in time. However, retinopathy screening attendance rates are below the recommended levels in many countries, including Ireland.


“We know from our own work with patients and health care professionals, along with the international evidence, that there are many reasons why people may not attend retinopathy screening. For example, they may not be aware of the risk of developing diabetic retinopathy, or that regular eye checks with opticians are different to retinopathy screening. People also may also find it difficult to access screening centres or have competing demands on their time.” says Principal Investigator, Dr Sheena McHugh.


Over a six-month period (July 2019 to January 2020) eight general practices across Ireland searched their practice records to identify patients who had not participated in screening. Four practices were asked to keep doing what they always do while the other four practices introduced a new system for reminding people about screening. This included reminding patients either in person, on the phone or by letter, and giving them a short leaflet from the practice with key messages about why they should go.


Lead author, Dr Fiona Riordan, said: “We found that in the four practices that introduced the changes, 31% of people (22 of 71) who had not attended RetinaScreen at the start of the study had attended screening by the end of the study. In the four practices that did not introduce the changes, 17% of people (15 of 87) had attended screening by the end of the study.”


“People with diabetes thought the reminders were acceptable and influenced their decision to attend screening. The reminder was influential because it came from their local practice where they trusted their GP and practice nurse. Some people were motivated to act when they got the reminder because they were already interested in their health or had concerns about their eyes.”


Staff thought that the new approach was a good idea and feasible to deliver but this depended on whether they could protect time to follow up with patients. They found ways to make the changes fit with their usual way of working and existing skillset.


Overall, the findings suggest the new approach could be a practical way to improve attendance. However, it was a small pilot study, and the researchers emphasised a full scale trial would be needed to be certain that the approach improves attendance.


According to the national diabetic retinopathy screening programme, there are about 190,000 people in Ireland with diabetes, and 19,000 of them are at risk of developing vision loss due to retinopathy. It is important to attend screening regularly. Current guidelines advise people with diabetes should attend screening once a year, or once every two years if there is a result of no retinopathy in the previous 2 screenings. To find out more and how you can participate in screening, visit the website or call Freephone: 1800 45 45 55.


The study was funded by the Health Research Board DIFA. The study has been published in BMJ Open. The full version of the published study can be found here.