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Cited by 26Retinal Diseases and TreatmentsRetinal Imaging and AnalysisOphthalmology and Visual Impairment Studies

Patients’ perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities

Open access
Zhu, Xiaofeng, Xu, Yi, Lu, Lina, Zou, Haidong·2020·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2019-000970PMC PMC7103829
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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.

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  • Compliance with referral suggestion for a full ocular examination among diabetic patients was 33% in one rural region of the Lifeline Express Program and 50.7% in urban regions.

    “Compliance with referral suggestion for a full ocular examination among diabetic patients was reported as 33% in one rural region of the Lifeline Express Program and as 50.7% in urban regions14,43,44.”

    From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [43]

    The Results (Sample characteristics; page unavailable) report 53.9% completed referrals in this study, not the claimed rural and urban rates. Searches for “Lifeline Express,” “33%,” and “50.7%” found no passage in our copy reporting those figures for the stated settings. (LLM, conf=0.75)

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Cited by

Sorted by citations

Authors
Zhu, X., Xu, Y., Lu, L., & Zou, H.
Affiliations
Shanghai Jiao Tong University (CN)
Corresponding author
  • Lu, Lina
  • Zou, Haidong
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2020-03
Volume
8
Issue
1
Pages
e000970
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2019-000970
PMC
PMC7103829
OpenAlex
W3011788479
Cited by
26
References
1
Citations by year
2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 1
FWCI
3.37
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Natural Science Foundation of China (81670898, 81700844)
  • The Shanghai Three Year Public Health Action Program (GWIV-3.3)
  • The Project of Shanghai Shen Kang Hospital Development Centre (SHDC2018110)
  • Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20172022)
  • Shanghai General Hosptial (CTCCR-2018Z01)
  • Science and Technology Commission of Shanghai Municipality (19DZ2205700)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
Keywords
diabetic retinopathy, telescreening, referral barriers, patient perspectives, vision-threatening diabetic retinopathy, patient knowledge and attitudes, transportation barriers, older adults, low educational attainment, referral compliance, physician-patient communication
MeSH terms
Aged, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Humans, Surveys and Questionnaires, Referral and Consultation, Logistic Models

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