Improving the Uptake of Screening in the Pacific: A Case Study of the Pacific Eye Institute

Abstract

Diabetes Retinal Screening (DRS) is vital to expediting the detection of diabetes retinopathy so that preventative action can be swiftly instigated. However, screening programmes typically suffer from suboptimal patient uptake and retention, with patients facing a unique set of endogenous and exogenous barriers to access. This thesis analysed routinely collected patient data from the Pacific Eye Institute (PEI) in Fiji to characterise; 1) the severity of diabetic retinopathy at presentation; 2) the scale of patient retention as a concern and; 3) the clinical and demographic patient characteristics associated with high clinic engagement. In the total study sample of 9287 new patients who attended the PEI for DRS between 2012 and 2017, sight-threatening diabetic retinopathy was found to be highly prevalent (28.6%) and glycaemic control poor. Patient retention was found to be a sizeable problem. Of 1584 new patients in the 2012 cohort only 25% were still in attendance in 2017. Across the years 80% of patient attrition occurred in the first year following presentation to the clinic. Marginal analysis showed patient attrition was in a group of ‘high engagers’. High clinic engagement was positively associated with female gender (1.23, p < 0.001), Indo-Fijian ethnicity, high glycaemia (compared to low, OR 1.93, p = 0.006) and peripheral neuropathy (OR 1.93 p = 0.004). Low clinic engagement was associated with STDR (OR 0.41, p = 0.003), iTaukei ethnicity (OR 0.35, p < 0.001), male gender, younger age (under 40 years of age, p < 0.001) and visual impairment (OR 0.39, p <0.001). The multiple logistic regression model accounted for a small amount in the variation between the two groups, and as such, further research will need to be conducted to determine core set of determinants of DRS utilisation at the PEI.