Mtuya Christina, Cleland Charles R, Philippin Heiko, Paulo Kidayi, Njau Bernard, Makupa William U, Hall Claudette, Hall Anthony, Courtright Paul, Mushi Declare
Kilimanjaro Christian Medical University College, Faculty of Nursing, Moshi, Tanzania.
Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
BMC Ophthalmol. 2016 Jul 19;16:115. doi: 10.1186/s12886-016-0288-z.
Diabetes is an emerging public health problem in sub-Saharan Africa. Diabetic retinopathy is the commonest microvascular complication of diabetes and is a leading cause of blindness, mainly in adults of working age. Follow-up is crucial to the effective management of diabetic retinopathy, however, follow-up rates are often poor in sub-Saharan Africa. The aim of this study was to assess the proportion of patients not presenting for follow-up and the reasons for poor follow-up of diabetic patients after screening for retinopathy in Kilimanjaro Region of Tanzania.
All diabetic patients referred to a tertiary ophthalmology hospital after screening for retinopathy in 2012 were eligible for inclusion in the study. A randomly selected group of patients from the community-based diabetic retinopathy screening register were identified; among this group, follow-up was assessed. Interviews were conducted within this group to inform on the reasons for poor follow-up.
Among the 203 patients interviewed in the study 50 patients (24.6 %) attended the recommended referral appointment and 153 (75.4 %) did not. Financial reasons were self-reported by 35.3 % of those who did not attend the follow-up appointment as the reason for non-attendance. Multiple logistic regression analysis showed that the patient report of the clarity of the referral process (p = 0.014) and the patient report of whether a healthcare worker told the patient that diabetic retinopathy could be treated (p = 0.005) were independently associated with attendance at a follow-up appointment. Income per month was not associated with attendance at a follow-up appointment on multivariate analysis.
Financial factors are commonly cited as the reason for non-compliance with follow-up recommendations. However, the reasons for poor compliance are likely to be more complicated. This study highlights the importance of health system factors. Improving the clarity of the referral process and frequent reminders to patients that diabetic retinopathy can be treated are practical strategies that should be incorporated into screening programmes to increase attendance at subsequent follow-up appointments. The results from this study are applicable to other screening programmes as well as those for diabetic retinopathy.
糖尿病在撒哈拉以南非洲地区正成为一个日益严重的公共卫生问题。糖尿病视网膜病变是糖尿病最常见的微血管并发症，是导致失明的主要原因，主要发生在工作年龄的成年人中。随访对于糖尿病视网膜病变的有效管理至关重要，然而，在撒哈拉以南非洲地区，随访率往往很低。本研究的目的是评估在坦桑尼亚乞力马扎罗地区对糖尿病患者进行视网膜病变筛查后未前来随访的患者比例以及随访不佳的原因。
2012年在进行视网膜病变筛查后被转诊至一家三级眼科医院的所有糖尿病患者均符合纳入本研究的条件。从基于社区的糖尿病视网膜病变筛查登记册中随机选取一组患者；在该组患者中评估随访情况。在该组患者中进行访谈以了解随访不佳的原因。
在本研究中接受访谈的203名患者中，50名患者（24.6%）参加了推荐的转诊预约，153名患者（75.4%）未参加。35.3%未参加随访预约的患者自述经济原因是未就诊的原因。多因素逻辑回归分析显示，患者对转诊流程清晰度的报告（p = 0.014）以及患者对医护人员是否告知患者糖尿病视网膜病变可治疗的报告（p = 0.005）与参加随访预约独立相关。多变量分析显示每月收入与参加随访预约无关。
经济因素通常被认为是不遵守随访建议的原因。然而，依从性差的原因可能更为复杂。本研究强调了卫生系统因素的重要性。提高转诊流程的清晰度并经常提醒患者糖尿病视网膜病变可治疗是应纳入筛查计划以提高后续随访预约就诊率的实用策略。本研究结果适用于其他筛查计划以及糖尿病视网膜病变筛查计划。
