Barriers and facilitators to diabetic retinopathy screening within Australian primary care

Abstract Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors aff...

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Autores principales:	Matthew J. G. Watson, Peter J. McCluskey, John R. Grigg, Yogesan Kanagasingam, Judith Daire, Mohamed Estai
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Diabetic retinopathy Screening Eye Photography Diabetes Primary care Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/deb0ad8a4b36462290a30ed2974a002f
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spelling	oai:doaj.org-article:deb0ad8a4b36462290a30ed2974a002f2021-12-05T12:20:38ZBarriers and facilitators to diabetic retinopathy screening within Australian primary care10.1186/s12875-021-01586-71471-2296https://doaj.org/article/deb0ad8a4b36462290a30ed2974a002f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12875-021-01586-7https://doaj.org/toc/1471-2296Abstract Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.Matthew J. G. WatsonPeter J. McCluskeyJohn R. GriggYogesan KanagasingamJudith DaireMohamed EstaiBMCarticleDiabetic retinopathyScreeningEyePhotographyDiabetesPrimary careMedicine (General)R5-920ENBMC Family Practice, Vol 22, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetic retinopathy Screening Eye Photography Diabetes Primary care Medicine (General) R5-920
spellingShingle	Diabetic retinopathy Screening Eye Photography Diabetes Primary care Medicine (General) R5-920 Matthew J. G. Watson Peter J. McCluskey John R. Grigg Yogesan Kanagasingam Judith Daire Mohamed Estai Barriers and facilitators to diabetic retinopathy screening within Australian primary care
description	Abstract Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.
format	article
author	Matthew J. G. Watson Peter J. McCluskey John R. Grigg Yogesan Kanagasingam Judith Daire Mohamed Estai
author_facet	Matthew J. G. Watson Peter J. McCluskey John R. Grigg Yogesan Kanagasingam Judith Daire Mohamed Estai
author_sort	Matthew J. G. Watson
title	Barriers and facilitators to diabetic retinopathy screening within Australian primary care
title_short	Barriers and facilitators to diabetic retinopathy screening within Australian primary care
title_full	Barriers and facilitators to diabetic retinopathy screening within Australian primary care
title_fullStr	Barriers and facilitators to diabetic retinopathy screening within Australian primary care
title_full_unstemmed	Barriers and facilitators to diabetic retinopathy screening within Australian primary care
title_sort	barriers and facilitators to diabetic retinopathy screening within australian primary care
publisher	BMC
publishDate	2021
url	https://doaj.org/article/deb0ad8a4b36462290a30ed2974a002f
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Barriers and facilitators to diabetic retinopathy screening within Australian primary care

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