Interventions to Increase Retinopathy Screening
Do printed materials Increase Primary Care physicans Referrals for retinopathy screening?
Grimshaw, J. M., Presseau, J., Tetroe, J., Eccles, M. P., Francis, J. J., Godin, G., Zwarenstein, M. (2014). Looking inside the black box: results of a theory-based process evaluation exploring the results of a randomized controlled trial of printed educational messages to increase primary care physicians' diabetic retinopathy referrals. Intervention Science, 9(86), 1-7. doi: 10.1186/1748-5909-9-86.
- Purpose: A theory based/random controlled trial to investigate if printed education materials (PEM) about the need for DRR screening would increase physician intentions to refer patients for DRR screening using any of three type of PEM (e.g., long or short messages or reminder note pads).
- Setting: Family physicians in Ontario, Canada.
- Number in study: Physicians volunteered via a postal survey. (n=431).
- Age: NA.
- Gender: NA
- Ethnicity: NA
- Results and method(s) of measurement: Data was collected via postal survey. Physicians were sent a pre-intervention survey two months before and a post-intervention survey six months after receiving the PEM intervention material. Results showed no behavior change in physician’s referral of persons with diabetes for DRR screening.
- Highlights of Results: The sub-optimal results suggest that behavior change is dependent on multiple factors that need to be considered when constructing the intervention. This study did not run a pilot to ascertain if printed factors alone would be sufficient to influence behavior change. The physician responses to post-intervention survey open-ended questions revealed various physician barriers (e.g., [the PCP] saw no change in vision, no need in asymptomatic patient, office time constraints, patient loss to follow-up and administrative/time requirement to write a referral letter) which could be used to formulate future interventions.
How does telemedicine screening of retinopathy compare with traditional Eye Examinations?
Mansberger, S. L., Sheppler, C., Barker, G., Gardiner, S. K., Demirel, S., Wooten, K., & Becker, T. M. (2015). Long-term comparative effectiveness of telemedicine in providing diabetic retinopathy screening examinations: A randomized clinical trial. JAMA Ophthalmology, 133(5), 518-525. doi: 10.1001/jamaophthalmol.2015.1
- Purpose: A 5 year randomized clinical trial to compare telemedicine (screening for DRR with digital retinal imaging) to traditional eye examinations in their efficacy to provide DRR screening examinations to address the public health issue of diabetes and diabetic retinopathy in rural areas.
- Setting: Two primary care clinics that serve a large number of American Indian/Alaska Native persons with diabetes between September 2006-August 2012.
- Number in study: 18 years or over diagnosed with diabetes or DRR (n=567).
- Age (mean value): 51.1 years
- Gender: ♂ (n=274), ♀ (n=293)
- Ethnicity: Asian (n=0), Black (n=102), Latino (n=62), White (n=301), Am. Indian/Alaska Native (n=95 or n=186 if secondary ethnicity was considered).
- Results and method(s) of measurement: Exam data was measured over a 54 month time span. Results over a one year period showed an increase of DRR exams/screening [50.7% (6 month) and 19.8% (12 month) interval] in the telemedicine only group vs. the traditional exam only group. When both methods were offered, an increase in DRR screening was observed although not statistically significant.
- Highlights of Results: The results suggest that offering DRR screening with digital retinal imaging could lower barriers for yearly DRR screening exams. When both methods of DRR evaluation were offered (e.g., telemedicine vs. traditional exam) 30% of participants would only use telemedicine, indicating its potential for increasing yearly screening rates by lowering behavioral barriers to care.
did a Public Heath / Social Media Campaign prevent vision loss by encouraging more frequent Eye Exams?
Muller, A., Keeffe, J. E., & Taylor, H. R. (2007). Changes in eye care utilization following an eye health promotion campaign. Clinical and Experimental Ophthalmology, 35(4), 305-309. doi: 10.1111/j.1442-9071.2007.01450.x
- Purpose: The Vision Initiative (TVI) was a public health/social media campaign in 2005 to prevent vision loss (including DRR) by encouraging more frequent comprehensive eye examinations. This was done via media (e.g., TV, radio, print) and through professional organizations (e.g., pharmacists, optometrists and ophthalmologists). A follow-up study was conducted to access the impact on people aged 70-79 years on visits to eye care specialists.
- Location: Melbourne, Australia.
- Demographics (follow up):
- Number in Study: (n=1728)
- Age (average value): 74.5 years
- Gender: ♂ (n=609), ♀ (n=1119)
- Ethnicity (speak English at home): (n=1540)
- Results and method(s) of measurement: A letter of invitation was randomly sent to citizens in possession of Australian Seniors Card issued to residents of Melbourne. Those responding were mailed a self-administered survey. The main outcome concerning DRR was participants reported having a dilated eye exam within 2 years increased from 52-70% (P<001).
- Highlights of Results: Although the study was not rigorous in its design, it demonstrated that a social media campaign can show statistically significant results in influencing exam behavior change.
Does written communication between PCP and Ophthalmology Improve Retinopathy screening appointments?
Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., & Haller, J. A. (2016). Impact of physician communication on diabetic eye examination adherence: Results from a retrospective cohort analysis. Retina-the Journal of Retinal and Vitreous Diseases, 36(1), 20-27. doi:10.1097/iae.0000000000000652
- Purpose: A retrospective study that evaluated if written communication between a primary care physician (PCP) and ophthalmologist (OMD) showed any improvement on yearly DRR eye exams.
- Setting: Administrative data and charts from an academic tertiary eye care center from 2007-2010 were evaluated (presumed to be in Philadelphia, Pennsylvania).
- Requirements and Demographics:
- Number in study: 40 years or over diagnosed with diabetes or DRR (n=1968).
- Age: No average or mean value provided.
- Gender: ♂ (n=1048), ♀ (n=861)
- Ethnicity: Asian (n=76), Black (n=1321), Latino (n=139), White (n=391)
- Results and method(s) of measurement: Prior records were assessed for evidence of communication between PCP’s and OMD’s. After controlling for variables a multivariable analysis indicated an odds ratio of 1.47 and 1.53 of eye exams if letters of communication were conducted from OMD to PCP and PCP to OMD respectively.
- Highlights of Results. Communications between OMD and PCP are more likely to highlight the need of DRR eye exams to health care workers and patients.
Is telephone intervention a better way to promote retinopathy screening appointments?
Walker, E. A., Schechter, C. B., Caban, A., & ☺Basch☺, C. E. (2008). Telephone intervention to promote diabetic retinopathy screening among the urban poor. American Journal of Preventive Medicine, 34(3), 185-191. doi:10.1016/j.amepre.2007.11.020
- Purpose: A randomized control study evaluated whether a 6 month tailored telephone intervention for urban minority diabetes populations, offered in English or Spanish, would result in greater DRR screening than a standard print intervention.
- Setting: Three healthcare centers in the Bronx, New York between 2001-2005..
- Requirements and Demographics:
- Number in study: Over 18 years, diagnosed with diabetes, able to speak or read/be read to in English or Spanish and not having a DRR dilated exam in previous 12 months. (n=598).
- Age: (mean value) = 56.6 years
- Gender: ♂ (n=237), ♀ (n=361)
- Language Preference: English (n=462), Spanish (n=136).
- Results and method(s) of measurement: The probability of a documented dilated fundus exam was 74% higher with the telephone intervention vs. print intervention [33.8% (telephone) vs. 18.5% (print)].
- Highlights of Results: It was found that the number of calls made a difference in DRR exams with the maximum effect on the fourth call and falling off dramatically after the fifth call. Secondly, although the relative risk did not differ between persons with poor, moderate or good glycemic management, data indicated that the cohort of persons with poorest self-management were most likely to have a DRR dilated exam with the telephone intervention (16.4% print vs. 43.1% telephone) when compared to the moderate and good categories.
Does 'BEHAVIORAL activation' increase the rate of dilated exams for retinopathy in AFRICAN American Population?
Weiss, D. M., Casten, R. J., Leiby, B. E., Hark, L. A., Murchison, A. P., Johnson, D., . . . Haller, J. A. (2015). Effect of behavioral intervention on dilated fundus examination rates in older African American individuals with diabetes mellitus: A randomized clinical trial. JAMA Ophthalmology, 133(9), 1005-1012. doi:10.1001/jamaophthalmol.2015.1760.
- Purpose: A 52 month randomized clinical trial to test the efficacy of behavioral activation (multiple interventions) for increasing dilated fundus exams for prevention of DRR in older African Americans diagnosed with diabetes vs. supportive care.
- Setting: Two academic medical centers and a community hospital in Philadelphia, Pennsylvania that served African American persons with diabetes during the dates of September 2010-August 2014.
- Requirements and Demographics:
- Number in study: 65 years or over diagnosed with type 2 diabetes and not DFE within 12 months that identified themselves as African American (n=206).
- Age (mean value): 72.7 years
- Gender: ♂ (n=72), ♀ (n=134)
- Ethnicity: Asian (n=0), African American (n=206), Latino (n=0), White (n=0), Am. Indian/Alaska Native (n=0).
- Results and method(s) of measurement: Four one hour sessions by community health workers were given in a four month period. Behavioral activation for “diabetic retinopathy prevention combined the principles of education about diabetes mellitus, behavioral therapy, and the health belief model to assist participants in identifying barriers to obtaining DFEs, problem-solving solutions to surmounting barriers, formulating action plans to facilitate DFEs, and gauging the success of action plans” vs. supportive therapy (control group). DFE’s were validated against clinical records at eye care centers. At 6 month follow up, the behavioral activation group was 2.58 times more likely to have a DFE within six months vs. the supportive therapy group (87.9% Activation vs. 34.1% Supportive).
- Highlights of Results: A DRR rate of 23% was higher than usually noted for routine DRR screening. Lastly, behavioral interventions can be successful at improving DRR dilated exam rates.