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Feasibility of an Intervention to Improve Attendance for Diabetic Retinopathy Screening

Diabetes is a serious public health concern. Much of the burden of diabetes is caused by progressive complications. Retinopathy is the most common microvascular complication of diabetes. It is a leading cause of blindness among the working age adult population. Retinal screening can prevent or delay the development of diabetic retinopathy. Despite evidence demonstrating its effectiveness, diabetic retinopathy screening rates consistently fall below recommended levels.
This research will investigate the feasibility of an intervention to increase retinopathy screening registration, consent and attendance using a cluster randomised pilot study design. The intervention will target general practice where most of the management of type 2 diabetes takes place.
We will establish the acceptability of the intervention strategies using the nominal group technique among stakeholders including GPs, practice nurses, patients and their advocates, and policy makers. Among eight purposively sampled practices we will conduct a cluster randomised pilot study. Four practices will be assigned to the intervention group involving audit and feedback for practice staff and a GP-endorsed reminder letter for patients with type 2 diabetes who have not consented/attended screening. Four practices will be assigned to the wait-list control group (intervention delivered after 6 months). A qualitative process evaluation will explore the acceptability of intervention delivery and study parameters including intervention fidelity among practice staff and patients with diabetes. We will estimate the economic cost of delivering the intervention from the healthcare provider perspective. Using the results we will estimate the budget impact of establishing and maintaining the intervention for the diabetes population in Ireland compared to routine care.
Developing structures and processes within the health system to support people to access care and prevent ill-health is a pillar of our national policy. The World Health Organisation (WHO) recommend the development of programmes to ensure equitable access to essential technology and services for the management of diabetes complications. This research will deliver an intervention,that is acceptable to and feasible for healthcare providers and people living with the demands of diabetes, with a viewto improving the uptake of screening, a necessary first step in the prevention ofdiabetic retinopathy.