Vulnerabilities in diabetic eye screening for children and young people in England
| Autor: | Ameenat Solebo, Jugnoo Rahi, Sobha Sivaprasad, Arvind Chandna, Ben Burton, Irene Stratton, Gerald Watts, Victor Chong |
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| Rok vydání: | 2019 |
| Předmět: |
Pediatrics
medicine.medical_specialty Referral Adolescent Endocrinology Diabetes and Metabolism Eye care Young Adult Diabetes mellitus Internal Medicine medicine Screening programs Diabetes Mellitus Humans Mass Screening Child Referral and Consultation Diabetic Retinopathy Primary Health Care business.industry Age Factors Infant Newborn Infant Secondary data Diabetic retinopathy Eye screening medicine.disease England Child Preschool Pediatrics Perinatology and Child Health Critical Pathways business Retinopathy Program Evaluation |
| Zdroj: | Pediatric diabetesREFERENCES. 20(7) |
| ISSN: | 1399-5448 |
| Popis: | Background Children and young people (CYP) living with diabetes require integrated child-centered care. We hypothesized that suboptimal uptake to diabetic retinopathy screening in CYP may be partly related to the degree of services integration. We investigated the structure of the current pediatric diabetic eye care pathway and associations between service-level characteristics and screening uptake. Methods A quality improvement project between January and May 2017 comprising a survey of practice of all 158 pediatric diabetes services (pediatric diabetes units, PDUs) across England and secondary data analysis of routinely collected service data. Generalized linear models for proportional responses were fitted to investigate associations between reported PDU characteristics and screening uptake. Results 124 PDUs (78%) responded. In 67% (n = 83), patients could be referred directly to screening programs; the remainder relied on primary care for onward referral. 97% (n = 120) considered eye screening results useful for counseling patients but only 65% (n = 81) reported it was "easy" to obtain them. Factors independently associated with higher screening uptake were a higher proportion of patients referred from primary care (OR = 1.005; 95%CI = 1.004-1.007 per 1% of increase), absence of "out-of-catchment area" patients (OR = 1.13; 95%CI = 1.04-1.22), and easy access to eye screening results (OR = 1.45; 95%CI = 1.34-1.56). Conclusions There is limited direct communication between the services involved in diabetic eye care for CYP in England. This risks reducing the effectiveness of diabetic retinopathy screening. Similar vulnerabilities are likely to exist in other countries where retinopathy screening for CYP has been "bolted on" to provision for adults. |
| Databáze: | OpenAIRE |
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