Effectiveness of Interventions to Promote Screening for Diabetic Retinopathy
Objective
To assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes.
Methods
A systematic literature search was conducted of multiple electronic bibliographic databases up to May 2005. Studies were included if interventions were used to promote screening for diabetic retinopathy in any language and with any study design.
Results
Forty-eight studies (12 randomized controlled trials [RCTs], four nonrandomized studies, and 32 pre–post studies) with a total of 162,157 participants, examined a wide range of interventions, which focused on one or more of the following: (1) patients or populations, (2) providers or practices, and (3) healthcare system infrastructure and processes. Four of five RCTs focusing on patients demonstrated that interventions increased screening significantly, with relative risk ranging from 1.05 (95% confidence interval [CI]=1.01–1.08) to 2.01 (95% CI=1.48–2.73). Five RCTs with a focus on the system all demonstrated significant increases in screening with relative risk ranging from 1.12 (95% CI=1.03–1.22) to 5.56 (95% CI=2.19–14.10). Thirty-six non-RCTs, which included interventions with single or multiple foci, also generally demonstrated positive effects.
Conclusions
Increasing patient awareness of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy. Further research should explore strategies for increasing the rate of retinal screening among diverse or disadvantaged populations and the economic efficiency of effective interventions in large community populations.
aDivision of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, Georgia
bOregon Health and Sciences University, Portland, Oregon
dDepartment of Medicine, David Geffen School of Medicine, University of California in Los Angeles, Los Angeles, California
eUniversity of Ottawa Eye Institute, Ottawa, Canada
Address correspondence and reprint requests to: Xuanping Zhang, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, MS K-10, 4770 Buford Highway NE, Atlanta GA 30341.
ABSTRACT