Why is this study important?
Diabetic retinopathy is a serious and common condition that affects the sight of people with diabetes and can cause blindness. Regular screening leads to retinopathy being picked up earlier and treated, which can help prevent or delay sight loss. In Ireland, retinopathy affects 8.2% of the population over 50 years with type 2 diabetes (approximately 10,000 people) and is one of the leading causes of blindness among adults of working age. Screening is effective and provided free of charge by the national retinopathy screening programme is Ireland, RetinaScreen. However, recent estimates suggest uptake is only about 61%. Studies show that people with diabetes experience barriers to attending screening, for example, lacking symptoms and being unaware they are at risk of retinopathy, being afraid of getting a bad result, and finding it difficult to access screening centres.
What are we not sure about?
Some interventions have been shown to improve uptake (e.g. patient reminders and education ), they can work differently depending on the context (e.g. population, region, health care setting). So, it is important to understand whether an intervention is feasible in the relevant context, and acceptable to the patients and professionals who receive the intervention. As most of the routine management of type 2 diabetes takes place in primary care, it is arguably the best setting for interventions to improve uptake of DRS. Furthermore, previous research has found recommendation to attend screening from a primary care professional, is an important enabler.
Although primary care is an appropriate setting in which to introduce interventions to target retinopathy screening uptake, few studies have tested interventions to improve retinopathy screening uptake in this context. The aim of the Improving Diabetes Eye screening Attendance (IDEAs) study is to investigate the feasibility of an intervention in general practice to improve the uptake of the national retinopathy screening programme.
What will we do?
IDEAs is a pilot cluster randomised controlled trial. Four general practices will receive the intervention while four will be part of a control group, who wait 6 months before receiving the intervention. Parts of the intervention (training in audit, a practice audit of uptake, electronic prompts on patient records, and practice reimbursement) target practice staff to help them to deliver targeted reminders to patients. The face-to-face, phone and postal reminders along with an information leaflet, will encourage patients to attend screening. During and after the trial we will check: 1) how many practices expressed an interest in taking part and how many of the eight practices who were recruited stay in the study; 2) how many people with diabetes are registered for and attend screening, and; 3) whether practices deliver the intervention as planned. We also want to check whether the intervention is acceptable and feasible by interviewing general practice staff and patients to see what they think about the way the intervention is delivered, and the study procedures, for example, the type of information we are collecting and the way it is being collected . Lastly, to estimate the cost of delivering the intervention in general practice we will record the resources and time needed to deliver the intervention.