Non-attendance at Diabetes Eye Services in South Auckland and the impact of Covid19

Abstract

Introduction: Regular eye health assessments for all people with diabetes are vital to prevent vision loss from diabetic retinopathy (DR), a common complication of diabetes. Diabetes Retinal Screening (DRS) services aim to detect people at risk of DR and refer them to the Ophthalmology Diabetes service for treatment. Unfortunately, across Aotearoa, New Zealand (NZ), access to diabetes eye care services is less than optimal. Fear of contracting Coronavirus Disease 2019 (Covid19) may be the latest addition to the barriers patients face to accessing diabetes eye care. Aims: The aims of this research study were to 1) explore and compare sociodemographic factors and 2) assess the impact of Covid19 on the non-attendance of people with diabetes at appointments at an out-patient tertiary Ophthalmology Diabetes and a community-based DRS service within the Counties Manukau District Health Board (CMDHB) region in South Auckland, Aotearoa between 1st January 2019 and 31st December 2020. Method: The study had two components. First, key informant interviews with staff from Ophthalmology and DRS services were undertaken to map the journey followed by people with diabetes when referred and the process(s) undertaken when they did not attend (DNA). Subsequently, a retrospective analysis of routinely collected data (CMDHB integrated patient management system) determined the attendance of people with diabetes at appointments during the study period. Sociodemographic factors, DNA rates, and comparisons between pre-Covid19 and Covid19 periods and with consideration of the NZ Covid19 alert levels were examined. Findings: The DRS service had several key strategies to enable attendance compared to Ophthalmology Diabetes. In total, there were 8,267 Ophthalmology Diabetes and 22,808 DRS service patients identified in the study period. DRS had significantly lower rates of patient non-attendance (4%) than Ophthalmology Diabetes (9%). Patients from particular age groups (≤59 years) and ethnic groups, namely Maaori and Pacific people, had a greater likelihood of non-attendance than people ≥ 60 years and NZ Europeans, respectively. A socioeconomic gradient in uptake was identified with the odds of non-attendance in those living in the most deprived areas being over twice as likely to DNA than in the least deprived areas. Attendance varied by Covid19 alert levels, with the highest nonattendance at level 3. Conclusion: The DNA rate at DRS was less than half the rate at Ophthalmology Diabetes clinics, possibly due to the additional strategies implemented by DRS to support attendance. The patient’s age, ethnicity, and socioeconomic status were associated with clinic non-attendance, and Covid19 alert level 3 appears to be an additional barrier to attendance for both services.