Vulnerabilities in diabetic eye screening for children and young people in England

on behalf of the Diabetic Eye Disease in Childhood Study (DECS) group

doi:10.1111/pedi.12887

Vulnerabilities in diabetic eye screening for children and young people in England

on behalf of the Diabetic Eye Disease in Childhood Study (DECS) group

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	932-940
Number of pages	9
Journal	Pediatric Diabetes
Volume	20
Issue number	7
Early online date	03 Jul 2019
DOIs	https://doi.org/10.1111/pedi.12887
Publication status	Published - 10 Oct 2019

Bibliographical note

Funding Information:
We thank all participating Pediatric Diabetic Units, the National Children & Young People's Diabetes Network and the members of the DECS group (Supplement file 1). This work was funded by the Ulverscroft Foundation, the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Institute of Child Health / Great Ormond Street Hospital NHS Foundation Trust, and Diabetes Research & Wellness Foundation. M. C. I.-B. was also funded by National Commission for Scientific and Technological Research in Chile (CONICYT). A. L. S. is funded, and J. S. R. is supported in part by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Professor Rahi is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funding organizations had no role in the design or conduct of this research.

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

child care
diabetic retinopathy
integrated health care systems
ophthalmology
screening programs

ASJC Scopus subject areas

Internal Medicine
Pediatrics, Perinatology, and Child Health
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/pedi.12887Licence: Unspecified

Cite this

@article{a39633cb29ae4be89ff781ccd35b752a,

title = "Vulnerabilities in diabetic eye screening for children and young people in England",

abstract = "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.",

keywords = "child care, diabetic retinopathy, integrated health care systems, ophthalmology, screening programs",

author = "Ibanez-Bruron, {Maria C.} and Solebo, {Ameenat L.} and Cumberland, {Phillippa M.} and Rahi, {Jugnoo S.} and S. Althauser and J. Anderson and J. Ashworth and O. Ayoola and P. Bhattacharyya and S. Biswas and C. Brand and D. Broadbent and A. Brown and B. Burton and A. Chandna and Chen, {H. C.} and V. Chong and S. Choudhary and H. Cilliers and M. Clarke and A. Cole and H. Cook and T. Criddle and T. Dabbs and N. Davies and J. Deane and S. Dhanoa and B. Dhillon and N. Dhingra and L. Dhir and T. Dugal and M. Eckstein and C. Egan and H. Eleftheriadis and El-Ghrably, {I. A.} and S. George and C. Goldsmith and R. Johnston and C. Jones and R. Khan and A. MacLeod and Owens, {D. R.} and T. Peto and T. Robinson and P. Scanlon and S. Sen and V. Sharma and R. Smith and D. Steel and J. Warner and {on behalf of the Diabetic Eye Disease in Childhood Study (DECS) group}",

note = "Funding Information: We thank all participating Pediatric Diabetic Units, the National Children & Young People's Diabetes Network and the members of the DECS group (Supplement file 1). This work was funded by the Ulverscroft Foundation, the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Institute of Child Health / Great Ormond Street Hospital NHS Foundation Trust, and Diabetes Research & Wellness Foundation. M. C. I.-B. was also funded by National Commission for Scientific and Technological Research in Chile (CONICYT). A. L. S. is funded, and J. S. R. is supported in part by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Professor Rahi is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funding organizations had no role in the design or conduct of this research. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

year = "2019",

month = oct,

day = "10",

doi = "10.1111/pedi.12887",

language = "English",

volume = "20",

pages = "932--940",

journal = "Pediatric Diabetes",

issn = "1399-543X",

publisher = "John Wiley & Sons Inc.",

number = "7",

}

TY - JOUR

T1 - Vulnerabilities in diabetic eye screening for children and young people in England

AU - Ibanez-Bruron, Maria C.

AU - Solebo, Ameenat L.

AU - Cumberland, Phillippa M.

AU - Rahi, Jugnoo S.

AU - Althauser, S.

AU - Anderson, J.

AU - Ashworth, J.

AU - Ayoola, O.

AU - Bhattacharyya, P.

AU - Biswas, S.

AU - Brand, C.

AU - Broadbent, D.

AU - Brown, A.

AU - Burton, B.

AU - Chandna, A.

AU - Chen, H. C.

AU - Chong, V.

AU - Choudhary, S.

AU - Cilliers, H.

AU - Clarke, M.

AU - Cole, A.

AU - Cook, H.

AU - Criddle, T.

AU - Dabbs, T.

AU - Davies, N.

AU - Deane, J.

AU - Dhanoa, S.

AU - Dhillon, B.

AU - Dhingra, N.

AU - Dhir, L.

AU - Dugal, T.

AU - Eckstein, M.

AU - Egan, C.

AU - Eleftheriadis, H.

AU - El-Ghrably, I. A.

AU - George, S.

AU - Goldsmith, C.

AU - Johnston, R.

AU - Jones, C.

AU - Khan, R.

AU - MacLeod, A.

AU - Owens, D. R.

AU - Peto, T.

AU - Robinson, T.

AU - Scanlon, P.

AU - Sen, S.

AU - Sharma, V.

AU - Smith, R.

AU - Steel, D.

AU - Warner, J.

AU - on behalf of the Diabetic Eye Disease in Childhood Study (DECS) group

N1 - Funding Information: We thank all participating Pediatric Diabetic Units, the National Children & Young People's Diabetes Network and the members of the DECS group (Supplement file 1). This work was funded by the Ulverscroft Foundation, the National Institute for Health Research (NIHR) Biomedical Research Centre at University College London Institute of Child Health / Great Ormond Street Hospital NHS Foundation Trust, and Diabetes Research & Wellness Foundation. M. C. I.-B. was also funded by National Commission for Scientific and Technological Research in Chile (CONICYT). A. L. S. is funded, and J. S. R. is supported in part by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Professor Rahi is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funding organizations had no role in the design or conduct of this research. Publisher Copyright: © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2019/10/10

Y1 - 2019/10/10

N2 - 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.

AB - 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.

KW - child care

KW - diabetic retinopathy

KW - integrated health care systems

KW - ophthalmology

KW - screening programs

U2 - 10.1111/pedi.12887

DO - 10.1111/pedi.12887

M3 - Article

C2 - 31270908

AN - SCOPUS:85068922820

SN - 1399-543X

VL - 20

SP - 932

EP - 940

JO - Pediatric Diabetes

JF - Pediatric Diabetes

IS - 7

ER -

Vulnerabilities in diabetic eye screening for children and young people in England

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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Cite this