The Effect on Patients’ Visual Acuity and Grade, Secondary to Non-Attendance at Treatment Centers, Post Referral from Diabetic RetinaScreen Ireland

Abstract

Background

Patient non-attendance following referral to hospital is a significant challenge, in particular, for persons with diabetes.

Aim

We sought to determine the impact on both visual acuity and the subsequent follow-up retinopathy grade of patients when they fail to attend Diabetic Retinopathy Treatment (DRT) Centers following referral from Diabetic RetinaScreen (DRS).

Methods

A retrospective analysis of patients discharged from DRT due to multiple consecutive missed appointments between January 2016 and June 2021. Patients discharged for non-attendance were compared with patients discharged from completed treatment.

Results

Of the 24,945 NEC patients referred to DRT, 5900 (24%) and 9345 (37%) were discharged back to DRS due to non-attendance and completed treatment, respectively. Those discharged for non-attendance were younger (60.7 v 63.4, p < 0.001) and had higher proportions of males (67% v 63%, p < 0.001) and people with type 1 diabetes (27% v 18%, p < 0.001). After attending rescreening after discharge, those discharged for non-attendance were significantly more likely to have a worsening of DR grade (26% v 8%, p < 0.001).

Conclusion

Despite being notified that further investigation (with possible treatment) was required post DRS, many diabetic patients failed to attend for further management of their eye care in DRT. These patients had worse visual outcomes compared to those that attended. Improved patient education and communication are required to mitigate against the consequences of non-attendance.

Keywords:

• maculopathy
• follow up
• HES
• DNA
• compliance

Ethics Statement

This study meets the categorization of clinical audit as per the National Office of Clinical Audit (NOCA) GDPR Assessment table. Further ethics review was not required by the Reference Research Ethics Committee Midlands Area and Corporate (Regional Health Area B), in accordance with research regulations of Ireland.

Disclosure

J Harmon, R Acheson, S McMahon and L O′Toole are either employed by or have contractual agreements with NEC. L O′Toole also reports personal fees from Novartis and Bayer, outside the submitted work. The authors report no other conflicts of interest in this work.