You are here

Article Text

Article menu

Download PDFPDF

Epidemiology/Health Services Research
Patients’ perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities
  1. Xiaofeng Zhu1,2,
  2. Yi Xu1,2,
  3. Lina Lu1,2,
  4. Haidong Zou1,2
  1. 1Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
  2. 2Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  1. Correspondence to Dr Haidong Zou; zouhaidong{at}hotmail.com; Dr Lina Lu; lulina781019{at}qq.com

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.

  • access to care
  • adherence to medical treatments
  • retinopathy screening
  • telemedicine
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000970

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • XFZ and YX contributed equally.

    • Contributors XFZ and YX analyzed and interpreted the data and wrote the manuscript. HDZ contributed to data management, statistical guidance, and reviewed and approved the manuscript. HDZ and LNL reviewed and approved the manuscript. HDZ, XFZ and LNL designed the study and reviewed and approved the manuscript. HDZ is the guarantor of this work and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding This work was supported by the National Natural Science Foundation of China (grant number: 81700844, 81670898), Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (grant number: 20172022), the Project of Shanghai Shen Kang Hospital Development Centre (grant number: SHDC2018110), The Shanghai Three Year Public Health Action Program (grant number: GWIV-3.3), Shanghai General Hosptial (grant number: CTCCR-2018Z01), and Science and Technology Commission of Shanghai Municipality (grant number:19DZ2205700).

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Institutional review board of Shanghai General Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Some or all data generated or used during the study are available from the corresponding author by request. (zouhaidong{at}hotmail.com).