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Cleland CR, Bascaran C, Makupa W, Shilio B, Sandi FA, Philippin H, Marques AP, Egan C, Tufail A, Keane PA, Denniston AK, Macleod D, Burton MJ. Artificial intelligence-supported diabetic retinopathy screening in Tanzania: rationale and design of a randomised controlled trial. BMJ Open 2024; 14:e075055. [PMID: 38272554 PMCID: PMC10824006 DOI: 10.1136/bmjopen-2023-075055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Globally, diabetic retinopathy (DR) is a major cause of blindness. Sub-Saharan Africa is projected to see the largest proportionate increase in the number of people living with diabetes over the next two decades. Screening for DR is recommended to prevent sight loss; however, in many low and middle-income countries, because of a lack of specialist eye care staff, current screening services for DR are not optimal. The use of artificial intelligence (AI) for DR screening, which automates the grading of retinal photographs and provides a point-of-screening result, offers an innovative potential solution to improve DR screening in Tanzania. METHODS AND ANALYSIS We will test the hypothesis that AI-supported DR screening increases the proportion of persons with true referable DR who attend the central ophthalmology clinic following referral after screening in a single-masked, parallel group, individually randomised controlled trial. Participants (2364) will be randomised (1:1 ratio) to either AI-supported or the standard of care DR screening pathway. Participants allocated to the AI-supported screening pathway will receive their result followed by point-of-screening counselling immediately after retinal image capture. Participants in the standard of care arm will receive their result and counselling by phone once the retinal images have been graded in the usual way (typically after 2-4 weeks). The primary outcome is the proportion of persons with true referable DR attending the central ophthalmology clinic within 8 weeks of screening. Secondary outcomes, by trial arm, include the proportion of persons attending the central ophthalmology clinic out of all those referred, sensitivity and specificity, number of false positive referrals, acceptability and fidelity of AI-supported screening. ETHICS AND DISSEMINATION The London School of Hygiene & Tropical Medicine, Kilimanjaro Christian Medical Centre and Tanzanian National Institute of Medical Research ethics committees have approved the trial. The results will be submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER ISRCTN18317152.
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Affiliation(s)
- Charles R Cleland
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - William Makupa
- Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Bernadetha Shilio
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Frank A Sandi
- Department of Ophthalmology, University of Dodoma School of Medicine and Nursing, Dodoma, Tanzania
| | - Heiko Philippin
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Eye Centre, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Egan
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, University College London, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, University College London, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, University College London, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, London, UK
| | - Alastair K Denniston
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, University College London, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, London, UK
- National Institute for Health and Care Research, Birmingham Biomedical Research Centre, Birmingham, UK
| | - David Macleod
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, University College London, Moorfields Hospital London NHS Foundation Trust and Institute of Ophthalmology, London, UK
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Rafiq MY, Krugman DW, Bapumia F, Enumah Z, Wheatley H, Tungaraza K, Gerrets R, Mfuko S, Hall BJ, Kasogela O, Litunu A, Winch P. Kansa talk: mapping cancer terminologies in Bagamoyo, Tanzania towards dignity-based practice. BMJ Glob Health 2023; 8:e012349. [PMID: 37580100 PMCID: PMC10432665 DOI: 10.1136/bmjgh-2023-012349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/09/2023] [Indexed: 08/16/2023] Open
Abstract
This paper reports and examines the results of qualitative research on the use of local cancer terminology in urban Bagamoyo, Tanzania. Following recent calls to unify evidence and dignity-based practices in global health, this research locates local medical sociolinguistics as a key place of entry into creating epistemologically autonomous public health practices. We used semistructured ethnographic interviews to reveal both the contextual and broader patterns related to use of local cancer terminologies among residents of Dunda Ward in urban Bagamoyo. Our findings suggest that people in Bagamoyo employ diverse terms to describe and make meanings about cancer that do not neatly fit with biomedical paradigms. This research not only opens further investigation about how ordinary people speak and make sense of the emerging cancer epidemic in places like Tanzania, but also is a window into otherwise conceptualisations of 'intervention' onto people in formerly colonised regions to improve a health situation. We argue that adapting biomedical concepts into local sociolinguistic and knowledge structures is an essential task in creating dignity-based, evidence-informed practices in global health.
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Affiliation(s)
- Mohamed Yunus Rafiq
- Department of Social Sciences, New York University Shanghai, Shanghai, Shanghai, China
- Center for Global Health Equity, NYU Shanghai, Shanghai, Shanghai, People's Republic of China
| | - Daniel W Krugman
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fatima Bapumia
- Research Fellow, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Zachary Enumah
- Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | - Kheri Tungaraza
- Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - René Gerrets
- Senior Research Fellow, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Steve Mfuko
- Alliance for Women, Children, and Youth Survivors, Bagamoyo, Tanzania, United Republic of
| | - Brian James Hall
- Department of Social Sciences, New York University Shanghai, Shanghai, Shanghai, China
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Global Health Equity, NYU Shanghai, Shanghai, People's Republic of China
| | - Optatus Kasogela
- Alliance for Women, Children, and Youth Survivors, Bagamoyo, Tanzania, United Republic of
| | - Athumani Litunu
- Alliance for Women, Children, and Youth Survivors, Bagamoyo, Tanzania, United Republic of
| | - Peter Winch
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Lestari YD, Adriono GA, Ratmilia R, Magdalena C, Sitompul R. Knowledge, attitude, and practice pattern towards diabetic retinopathy screening among general practitioners in primary health centres in Jakarta, the capital of Indonesia. BMC PRIMARY CARE 2023; 24:114. [PMID: 37170199 PMCID: PMC10176940 DOI: 10.1186/s12875-023-02068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is an emerging cause of visual impairment and blindness and is often detected in the irreversible stage. General practitioners (GPs) play an essential role in the prevention of DR through diabetes control, early detection of retinal changes, and timely referral to ophthalmologists. This study aimed to determine the knowledge, attitude, and practice (KAP) towards DR screening among GPs in the district primary health centres (PHCs) in Jakarta, Indonesia. METHODS A cross-sectional study was conducted between April 2021 and February 2022 in 17 randomly selected district PHCs. A validated online questionnaire was then distributed. Good knowledge was defined when the correct response rate was > 75%, positive attitude was indicated when desired attitudes were found in more than half of the items (> 50%), and good practice was defined when more than half of the practice items (> 50%) were performed. RESULTS A total of 92 GPs, with a response rate of 60.1%, completed the questionnaire. Seventy-nine respondents (85.9%) were female with a median (range) age of 32 (24-58) years. Among the respondents, 82 (89.1%) had good knowledge and all showed positive attitude on DR screening. However, only four (4.3%) demonstrated good practices. We found a weak positive correlation (rs = 0.298, p = 0.004) between attitude and practices. CONCLUSION GPs in Jakarta showed good knowledge and positive attitude on DR screening. However, they did not show good practice. There was a positive correlation between attitude and practice.
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Affiliation(s)
- Yeni Dwi Lestari
- Ophthalmology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani Adriono
- Ophthalmology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Rizka Ratmilia
- Ophthalmology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Christy Magdalena
- Ophthalmology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ratna Sitompul
- Ophthalmology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Amritanand A, Arthur A, Horo S, Obed P, Ramamurthy P, Rebekah G, Abraham VJ, Paul P. Comparative evaluation of diabetic retinopathy screening programs in regular ophthalmology clinics versus integrated diabetic clinics within rural health-care services. Oman J Ophthalmol 2023; 16:237-243. [PMID: 37602185 PMCID: PMC10433048 DOI: 10.4103/ojo.ojo_195_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 03/25/2023] [Accepted: 05/24/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Robust integration of diabetic retinopathy (DR) screening within health systems is essential to prevent DR-related blindness. This, however, remains a challenge in the developing world. The aim of this study was to evaluate two models of DR screening programs within rural general health-care services. MATERIALS AND METHODS This was a retrospective observational study from two rural health centers. Demographic and clinical data of patients completing DR screening were analyzed. Patients were screened in regular ophthalmology clinics (ROC) or integrated diabetic clinics (IDC). Referral and treatment completion data were retrieved from the clinical charts at the base hospital. RESULTS A total of 2535 DR screenings were conducted for 2296 patients. The total population prevalence for any DR was 14.2% (95% confidence interval [CI]: 12.8%-15.6%) and vision-threatening DR (VTDR) was 4.7% (95% CI: 3.8%-5.6%). In the ROC and IDC groups, respectively, the prevalence of any DR was 20.4% and 8.2%, VTDR, 7.8% and 1.7%, and blindness, 1.4% and 0.4% (all P < 0.001). Referral completion rates were higher in the ROC group (44.8% vs. 25.2%, P < 0.001), while treatment completion in both was similar (69.6% vs. 70.6%). Referral and treatment completion rates for referable DR were 61.2% and 48.2%, and for VTDR, 62% and 38.8%, respectively. Only 11.45% of patients completed the repeat screening follow-up. CONCLUSIONS Patients attending IDCs had a significantly lower prevalence of any DR, VTDR, and blindness demonstrating the advantages of integrated diabetic care in a rural setting. However, referral uptake and DR treatment completion need strengthening.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anupriya Arthur
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Saban Horo
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prathibha Obed
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prashanth Ramamurthy
- Department of Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinod Joseph Abraham
- Department of Community Health and Development, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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Mathenge W, Whitestone N, Nkurikiye J, Patnaik JL, Piyasena P, Uwaliraye P, Lanouette G, Kahook MY, Cherwek DH, Congdon N, Jaccard N. Impact of Artificial Intelligence Assessment of Diabetic Retinopathy on Referral Service Uptake in a Low-Resource Setting: The RAIDERS Randomized Trial. OPHTHALMOLOGY SCIENCE 2022; 2:100168. [PMID: 36531575 PMCID: PMC9754978 DOI: 10.1016/j.xops.2022.100168] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 06/02/2023]
Abstract
PURPOSE This trial was designed to determine if artificial intelligence (AI)-supported diabetic retinopathy (DR) screening improved referral uptake in Rwanda. DESIGN The Rwanda Artificial Intelligence for Diabetic Retinopathy Screening (RAIDERS) study was an investigator-masked, parallel-group randomized controlled trial. PARTICIPANTS Patients ≥ 18 years of age with known diabetes who required referral for DR based on AI interpretation. METHODS The RAIDERS study screened for DR using retinal imaging with AI interpretation implemented at 4 facilities from March 2021 through July 2021. Eligible participants were assigned randomly (1:1) to immediate feedback of AI grading (intervention) or communication of referral advice after human grading was completed 3 to 5 days after the initial screening (control). MAIN OUTCOME MEASURES Difference between study groups in the rate of presentation for referral services within 30 days of being informed of the need for a referral visit. RESULTS Of the 823 clinic patients who met inclusion criteria, 275 participants (33.4%) showed positive findings for referable DR based on AI screening and were randomized for inclusion in the trial. Study participants (mean age, 50.7 years; 58.2% women) were randomized to the intervention (n = 136 [49.5%]) or control (n = 139 [50.5%]) groups. No significant intergroup differences were found at baseline, and main outcome data were available for analyses for 100% of participants. Referral adherence was statistically significantly higher in the intervention group (70/136 [51.5%]) versus the control group (55/139 [39.6%]; P = 0.048), a 30.1% increase. Older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.05; P < 0.0001), male sex (OR, 2.07; 95% CI, 1.22-3.51; P = 0.007), rural residence (OR, 1.79; 95% CI, 1.07-3.01; P = 0.027), and intervention group (OR, 1.74; 95% CI, 1.05-2.88; P = 0.031) were statistically significantly associated with acceptance of referral in multivariate analyses. CONCLUSIONS Immediate feedback on referral status based on AI-supported screening was associated with statistically significantly higher referral adherence compared with delayed communications of results from human graders. These results provide evidence for an important benefit of AI screening in promoting adherence to prescribed treatment for diabetic eye care in sub-Saharan Africa.
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Affiliation(s)
- Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology, Kigali, Rwanda
- Orbis International, New York, New York
| | | | - John Nkurikiye
- Rwanda International Institute of Ophthalmology, Kigali, Rwanda
- Rwanda Military Hospital, Kigali, Rwanda
| | - Jennifer L. Patnaik
- Orbis International, New York, New York
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Prabhath Piyasena
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | | | - Malik Y. Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Nathan Congdon
- Orbis International, New York, New York
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Curran K, Lohfeld L, Congdon N, Peto T, Hoang TT, Nguyen HT, Nguyen QN, Nguyen VT, Dardis C, Tran H, Tran HH, Vu AT, Tung MQ. Ophthalmologists' and patients' perspectives on treatments for diabetic retinopathy and maculopathy in Vietnam: a descriptive qualitative study. BMJ Open 2022; 12:e055061. [PMID: 35798521 PMCID: PMC9263907 DOI: 10.1136/bmjopen-2021-055061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Globally, diabetic retinopathy (DR) is the leading cause of blindness in working-aged adults. Early detection and treatment of DR is essential for preventing sight loss. Services must be available, accessible and acceptable to patients if we are to ensure they seek such care. OBJECTIVES To understand patients' knowledge and attitudes towards laser versus antivascular endothelial growth factor (VEGF) injections to treat DR in Vietnam, and to identify factors Vietnamese ophthalmologists consider when making treatment decisions. METHODS This is a descriptive qualitative study based on semi-structured interviews with 18 patients (12 from Ho Chi Minh City and 6 from Hanoi) plus individual interviews with 24 ophthalmologists working in eye clinics in these cities. Thematic analysis was used to analyse the data. RESULTS In total, 10/24 (41.7%) ophthalmologists were female, and their median age was 41 years (range 29-69 years). The median age of patients was 56.5 years (range 28-72 years), and 7/18 (38.9%) were female. Briefly, factors that influence DR treatment decisions for ophthalmologists are medical considerations (ie, severity of disease, benefits and risks), availability (ie, treatment and resources) and patient-related factors (ie, costs and adherence). Patient's perceived barriers and facilitators to treatments were based on patient and family related factors (ie, treatment and transportation costs) and previous treatment experiences (ie, positive and negative). Recommendations by all participants included ensuring that both laser and anti-VEGF injections are widely available across the country and controlling costs for patients and the healthcare system. CONCLUSIONS Reducing DR treatment costs, optimising treatments options, and expanding the network of clinics offering treatment outside metropolitan areas were the main issues raised by participants. These findings can help inform policy changes in Vietnam and may be generalisable to other low-resource settings.
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Affiliation(s)
- Katie Curran
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Lynne Lohfeld
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Wenzhou Medical University Eye Hospital, Wenzhou University, Wenzhou, China
| | - Nathan Congdon
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tunde Peto
- Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Tung Thanh Hoang
- Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | | | - Quan Nhu Nguyen
- Department of Vitreo-Retina, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
| | - Van Thu Nguyen
- Monitoring, Evaluation and Learning, Orbis International, Hanoi, Vietnam
| | - Catherine Dardis
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
| | - Hoang Tran
- Leadership, Orbis International, Hanoi, Vietnam
| | - Hoang Huy Tran
- Department of Community, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
| | - Anh Tuan Vu
- Institute of Ophthalmology, Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Mai Quoc Tung
- Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
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Establishing a screening programme for diabetic retinopathy in Kilimanjaro Region, Tanzania using intervention mapping. Eye (Lond) 2022; 36:17-24. [PMID: 35590051 PMCID: PMC9159027 DOI: 10.1038/s41433-022-02001-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Kilimanjaro Diabetic Programme used the Intervention Mapping framework to develop a theory- and evidence-based diabetic retinopathy screening programme. A Working Committee of health care workers and stakeholders ensured community engagement and empowerment of the target audience. Objectives To deliver a culturally appropriate, sustainable, community supported health intervention, promoting eye health behaviour change, to prevent avoidable blindness. Methods The six steps of the Intervention Mapping protocol incorporated eight components: (1) a needs assessment of people with diabetes and health care workers (2) a clinical trial of diabetic retinopathy screening modes, (3) comic strips as a motivational strategy for diabetic retinopathy screening uptake, (4) health care worker education (5) an electronic database of people with diabetes (6) a self-carry diary (7) implementation of mobile diabetic retinopathy retinal screening (8) process and outcome programme evaluation. Results The programme eliminated barriers to diabetic retinopathy screening in Kilimanjaro Christian Medical Centre eye and diabetic clinics, placing a digital retinal screening camera in the diabetic clinic and a fast-track screening system in the eye clinic. Two comic strips and a diary provided information about self-management and record of medications, treatment, blood sugar and blood pressure at clinic visits. An annual rural health care worker education programme met requests for knowledge on treatment and care of diabetes, targeting prevention of diabetic retinopathy. Rural digital retinal screening was implemented. Rural diabetes clinics were initiated. Conclusions Intervention Mapping provided a systematic, iterative model to formulate and deliver an urban and rural diabetic retinopathy screening programme. Trial registration number ISRCTN31439939. Details available at https://www.isrctn.com/
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Gender bias within a diabetic retinopathy screening programme in Tanzania. Eye (Lond) 2022; 36:33-39. [PMID: 35590053 PMCID: PMC9159029 DOI: 10.1038/s41433-022-02004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Kilimanjaro Diabetic Programme has been running since 2010 and screens persons with diabetes for diabetic retinopathy (DR). It was noted that women were less likely to attend follow-up appointments compared to men. The aim of this study was to explore gender biases amongst persons registered with the screening programme. METHODS A prospective mixed-methods study was carried out using a questionnaire of closed-ended questions and a semi-structured interview guide. RESULTS Of the 300 participants included in the quantitative component of the study, 193 (64.3%) were female and 107 (35.7%) were male. Females were significantly less educated (p < 0.001) and self-reported as less likely to attend the tertiary hospital if referred (p = 0.022). Of the married participants, on multivariate analysis, men were significantly more likely to make both financial decisions in the household (p = 0.001) and to decide if, and when, family members should attend hospital compared to women (p = 0.0048), independent of age, education level and whether they were from an urban or rural area. Qualitative analysis of the 33 interviews revealed a good understanding of the threat to vision from DR, but limited appreciation of disease chronicity. A common theme was that men are regarded as the head of the household and therefore make the financial decisions; this was especially true in less educated families. CONCLUSION As screening and treatment facilities for DR are developed in SSA, it is important that strategies are employed to reduce the burden of blindness and visual impairment from the under-utilisation of diabetic eye care services by women.
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Wentzel A, Mchiza ZJR. Exploring Factors Associated with Diabetic Retinopathy Treatment Compliance Behaviour in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212209. [PMID: 34831965 PMCID: PMC8617604 DOI: 10.3390/ijerph182212209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.
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Affiliation(s)
- Annalie Wentzel
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Correspondence:
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Non-Communicable Disease Research Unit, South African Medical Research Council, Parow Valley, Cape Town 7501, South Africa
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de Jong M, Peters SAE, de Ritter R, van der Kallen CJH, Sep SJS, Woodward M, Stehouwer CDA, Bots ML, Vos RC. Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:617902. [PMID: 33859615 PMCID: PMC8043152 DOI: 10.3389/fendo.2021.617902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications. Methods PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias. Results Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams. Conclusion Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.
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Affiliation(s)
- Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rianneke de Ritter
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Simone J. S. Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Netherlands
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rimke C. Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department Public Health and Primary Care / LUMC-Campus The Hagua, Leiden University Medical Center, Hague, Netherlands
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11
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Sia JT, Gan ATL, Soh BP, Fenwick E, Quah J, Sahil T, Tao Y, Tan NC, Sabanayagam C, Lamoureux EL, Man REK. Rates and Predictors of Nonadherence to Postophthalmic Screening Tertiary Referrals in Patients with Type 2 Diabetes. Transl Vis Sci Technol 2020; 9:15. [PMID: 32821512 PMCID: PMC7408802 DOI: 10.1167/tvst.9.6.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/25/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the rates and develop an initial risk prediction model for nonadherence to post screening ophthalmic referral (PSOR) in type 2 diabetes mellitus (T2DM) patients attending a national diabetic retinopathy screening program in Singapore. Methods Data from 2387 patients with T2DM (mean [standard deviation] age: 66.5 [11] years; 52.5% female patients) who underwent teleophthalmic screening between 2010 and 2014 under the Singapore Integrated Diabetic Retinopathy Program were extracted from electronic medical records. All were referred for tertiary ophthalmic management at the Singapore National Eye Centre (SNEC). Nonadherence was defined as not attending the SNEC appointment within 6 months of the assigned appointment date. Regression analysis using traditional modified Poisson and conditional inference models was used to construct and evaluate the discriminative ability of the preliminary risk prediction model to identify nonadherent individuals. Results Nonadherence rates to PSOR was 12.7% (95% confidence interval, 11.4%–14.1%). In traditional multivariable models adjusted for sociodemographic, lifestyle, and ocular factors, nonadherent individuals had higher triglyceride levels and were less likely to have a referable eye condition (P < 0.05). This model was able to identify nonadherent individuals with an accuracy (area under the curve) of 84%. In contrast, the conditional inference model was able to achieve similar discriminative ability using only participants’ ocular health characteristics. Conclusions The rates of nonadherence to PSOR in Singaporean individuals with T2DM is low, with better ocular health being strongly predictive of nonadherence in our Asian population. Translational Relevance Our results may inform interventions to decrease nonadherence to PSOR.
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Affiliation(s)
- Josh Tjunrong Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - BaoLin Pauline Soh
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Eva Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke National University of Singapore Medical School, Singapore
| | - Joanne Quah
- SingHealth Polyclinics, Singapore.,SingHealth Duke National University of Singapore, Family Medicine Academic Clinical Program, Singapore
| | - Thakur Sahil
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Yijin Tao
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Department of Ophthalmology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore.,SingHealth Duke National University of Singapore, Family Medicine Academic Clinical Program, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke National University of Singapore Medical School, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke National University of Singapore Medical School, Singapore.,Department of Ophthalmology, National University of Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke National University of Singapore Medical School, Singapore
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12
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Zhu X, Xu Y, Lu L, Zou H. Patients' perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities. BMJ Open Diabetes Res Care 2020; 8:8/1/e000970. [PMID: 32193199 PMCID: PMC7103829 DOI: 10.1136/bmjdrc-2019-000970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To understand the referral completion and explore the associated barriers to the referral after telescreening for diabetic retinopathy (DR) among people with vision-threatening DR (VTDR). RESEARCH DESIGN AND METHODS All participants with VTDR after DR telescreening in the communities completed the self-reported questionnaires to assess referral completion and their perspectives on referral barriers. Sociodemographic characteristics and perceived barriers related to incomplete referrals were identified by conducting univariate analysis and multiple logistic regression model. The final model was then built to predict incomplete referral. RESULTS Of the 3362 participants, 46.1% had incomplete referral. Old age and lower education level showed significant association with incomplete referral. Almost all participants had at least one barrier during the referral process. Knowledge-related and attitude-related barriers, including 'Too old to want any more treatment', 'Difficulty in getting time to referral', 'No serious illness requiring treatment at present', 'My eyes are okay', 'Distrust the recommended hospital' and 'Have not been diagnosed or treated before', and logistics-related barrier 'Mobility or transportation difficulties' showed significant association with incomplete referral. CONCLUSIONS The issue of incomplete referral after DR telescreening is serious among individuals with VTDR, particularly in the elder and low education level population. The negativity of knowledge-related and attitude-related factors might be more prominent than logistic barriers in predicting incomplete referral. Therefore, new strategies to improve the compliance with referral assist in optimizing the referral accessibility, and the ongoing educational support to improve the awareness of disease and increase the effectiveness of physician-patient communication.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Boucher MC, Ouazani Chahdi H, El Yamani MEM. Compliance to follow-up care after urban diabetic retinopathy tele-screening. Can J Ophthalmol 2020; 55:2-7. [DOI: 10.1016/j.jcjo.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 12/01/2022]
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14
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Alshareef SM, Aldayel AY, AlKhathlan MA, Alduaij KO, Alshareef FG, Al-Harthi ME, Aldayel AA, Shadid AM, Dahmash AB. Diabetic patients in Saudi Arabia: The evaluation of glycemic control measures based on emergency department utilization and the percentages of adherence to the recommended follow-ups for microvascular complications. Saudi Med J 2019; 40:271-276. [PMID: 30834423 PMCID: PMC6468210 DOI: 10.15537/smj.2019.3.23968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the association between emergency department (ED) visits, glycemic control and the quality of preventive diabetes care among diabetic patients in a Saudi community. Methods: This study was an observational, cross-sectional study that collected data through interview-based surveys between February and April 2017. Data were collected from 530 diabetic patients in the diabetes clinics at King Saud Medical City, the tertiary center of Riyadh, Kingdom of Saudi Arabia. Results: This study found statistically significant relationships (p<0.05) between ED visits and patient age, the glycated hemoglobin (HbA1c) and education level. Emergency department visits increased by 43% for each unit of increase in HbA1c (odds ratio [OR]=1.43, 95% confidence interval (CI)=1.26-1.62). Graduating from high school decreased the odds of visiting the ED by 43% (OR=0.57, 95% CI=0.34-0.94). Most of the participants were not followed for possible microvascular complications; the majority did not visit nephrology (96.2%), ophthalmology (78.3%) and neurology (97.9%) clinics within the 12 months prior to the interviews. Conclusion: Emergency department visits can indicate poor glycemic control in diabetic patients. Additionally, the current practices of preventive diabetes care in Saudi Arabia are not sufficient, according to the diabetic standards of care recommended by the American Diabetes Association.
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Affiliation(s)
- Saad M Alshareef
- Department of Medicine, Al Imam Mohammad Ibn Saud Islamic University,Ministry of Education, Riyadh, Kingdom of Saudi Arabia. E-mail.
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15
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Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA. United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. Br J Ophthalmol 2019; 103:837-843. [PMID: 30269098 PMCID: PMC6582816 DOI: 10.1136/bjophthalmol-2018-312568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. METHODS This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. RESULTS 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). CONCLUSIONS This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
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Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Aaron Y Lee
- University of Washington, Seattle, Washington, USA
| | | | | | - Clare Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peck-Lin Lip
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, UK
| | - Esther Cook
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK
| | | | | | | | - Randhir Chavan
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | | | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Centre at Bedford Hospital, Bedford, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | | | - Helen Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Bobby Paul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Dawn A Sim
- Moorfields Eye Centre at Croydon University Hospital, London, UK
| | | | | | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
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16
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Wong IYH, Ni MY, Wong IOL, Fong N, Leung GM. Saving sight in China and beyond: the Lifeline Express model. BMJ Glob Health 2018; 3:e000766. [PMID: 30147943 PMCID: PMC6104791 DOI: 10.1136/bmjgh-2018-000766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022] Open
Abstract
Cataract and diabetic retinopathy are leading causes of blindness globally. Lifeline Express (LEX) has pioneered the provision of cataract surgery in rural China from custom-built trains and eye centres nationwide. Over the past two decades, LEX has provided free cataract surgery for over 180 000 patients in China. In China, half of the adult population has prediabetes and 113 million adults have diabetes. Recognising the rising threat of diabetic retinopathy, LEX has expanded to providing free diabetic retinopathy screening nationwide by establishing 29 Diabetic Retinopathy Screening Centres across China. Source of referrals included host hospitals, the community and out-reach mobile vans equipped with fundus cameras. Fundi photos taken in the mobile vans were electronically transferred to primary graders. LEX also leveraged the widespread smartphone use to provide electronic medical reports via WeChat, the most popular instant messenger app in China. From April 2014 to December 2016, 34 506 patients with diabetes underwent screening, of which 27.2% (9,396) were identified to have diabetic retinopathy. China's latest national health strategy ('Healthy China 2030 Plan') has championed the 'prevention first' principle and early screening of chronic diseases. LEX has accordingly evolved to extend its services to save sight in China-from cataract surgery to diabetic retinopathy screening and most recently outreaching beyond its national borders in a pilot South-South collaboration. With health at the top of the China's developmental agenda and the country's growing role in global health-LEX's large-scale telemedicine-enabled programme could represent a potentially scalable model for nationwide diabetic retinopathy screening elsewhere.
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Affiliation(s)
- Ian Yat Hin Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Michael Yuxuan Ni
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Irene Oi Ling Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Nellie Fong
- Lifeline Express, Lifeline Express Hong Kong Foundation, Hong Kong, China
- Chinese Foundation for Lifeline Express, Beijing, China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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17
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Amritanand A, Paul P, Jasper S, Kumar SPV, Abraham V. Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India - An observational study. Indian J Ophthalmol 2018; 66:957-962. [PMID: 29941739 PMCID: PMC6032735 DOI: 10.4103/ijo.ijo_144_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Over 20% of the world's visually impaired and blind populations live in India. Integration of primary eye care (PEC) into existing primary health care by trained personnel could address access-related barriers. We piloted an unreported, modified WHO disability questionnaire-based model for community health workers (CHWs) to screen and refer persons with perceived visual impairment instead of the traditional visual acuity model. The objective of the study was (1) to determine the prevalence of perceived visual impairment, rate of follow-up postreferral, distribution of ocular morbidity, visual impairment, and proportion of appropriate referrals and (2) to compare results of this intervention with those of existing services. Methods: CHWs were trained in administering a questionnaire for identification and referral of persons with perceived visual impairment in 7 rural villages and 22 tribal hamlets from the institutional database. In this cross-sectional study, patients screened and referred to PEC services from September 2014 to March 2015 underwent comprehensive ocular examination by an optometrist and ophthalmologist. Data collected from their records were analyzed retrospectively. Results: Of 18,534 individuals screened, 3082 (16.64%, 95% confidence interval: 16.06–17.14) complained of perceived visual impairment and were referred; 463 (15%) of these followed up for examination. Correct referrals were noted in 452 (97.6%) cases. Cataract (52.3%) and refractive error (15.8%) were the most common morbidities. There was a 39.6% increase in uptake of eye care services from baseline. Conclusion: The questionnaire-based screening tool administered by CHWs can lead to appropriate identification and referral of persons with ocular morbidity impacting uptake of eye care services.
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Affiliation(s)
- Anika Amritanand
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Padma Paul
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vinod Abraham
- Community Health, Christian Medical College, Vellore, Tamil Nadu, India
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Smith-Morris C, Bresnick GH, Cuadros J, Bouskill KE, Pedersen ER. Diabetic Retinopathy and the Cascade into Vision Loss. Med Anthropol 2018; 39:109-122. [PMID: 29338335 DOI: 10.1080/01459740.2018.1425839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vision loss from diabetic retinopathy should be unnecessary for patients with access to diabetic retinopathy screening, yet it still occurs at high rates and in varied contexts. Precisely because vision loss is only one of many late-stage complications of diabetes, interfering with the management of diabetes and making self-care more difficult, Vision Threatening Diabetic Retinopathy (VTDR) is considered a "high stakes" diagnosis. Our mixed-methods research addressed the contexts of care and treatment seeking in a sample of people with VTDR using safety-net clinic services and eye specialist referrals. We point to conceptual weaknesses in the single disease framework of health care by diagnosis, and we use the framework of "cascades" to clarify why and how certain non-clinical factors come to bear on long-term experiences of complex chronic diseases.
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Affiliation(s)
- Carolyn Smith-Morris
- Department of Anthropology, Southern Methodist University, Dallas, Texas, United States
| | - George H Bresnick
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Jorge Cuadros
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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20
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Cancelled Primary Care Appointments: A Prospective Cohort Study of Diabetic Patients. J Med Syst 2017; 41:53. [PMID: 28214994 DOI: 10.1007/s10916-017-0700-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior. The independent variable was the status of the INDEX appointment, which was attended, cancelled, or no showed. Dependent variables included the dates of (1) the last attended appointment, (2) scheduling the NEXT appointment, (3) the next attended follow-up appointment, and (4) ED visits and hospitalizations within six months of the INDEX. Cancellation was more prevalent than no show (17.7% vs 12.2%). Of those who cancelled and scheduled a next appointment, 28.8% experienced over 30 days delay between the INDEX and NEXT appointment dates, and 59.9% delayed rescheduling until on or after the cancelled appointment date. Delay in rescheduling was associated with an 18.6% increase in days between attended appointments and a 26.0% increase in ED visits. For diabetic patients, cancellation with late rescheduling is a prevalent and unhealthy behavior. Although more work is necessary to address the health, intervention, and cost issues, this work suggests that cancellation, like no show, may be problematic for many clinics and patients.
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