Feasibility of a theory-based implementation intervention to increase attendance at diabetic retinopathy screening: a cluster randomised pilot trial

Problem

Although diabetic retinopathy screening (DRS) can prevent blindness, uptake remains sub-optimal in many countries, including Ireland. Routine management of type 2 diabetes largely takes place in general practice with frequent contact between GPs and other primary care staff and people with diabetes. However, few studies have tested the feasibility of interventions delivered in general practice to enhance DRS uptake. To address this gap, we aimed to investigate the feasibility of the IDEAs (Improving Diabetes Eye-screening Attendance) intervention to improve the uptake of DRS in Ireland’s national programme, RetinaScreen.

Approach

A cluster randomised pilot trial with an embedded process evaluation and cost analysis is ongoing. Expressions of interest were sought through established GP networks. Following stratification of interested practices by size, eight practices (clusters) were randomly sampled and allocated to intervention (n=4) or wait-list control arms (n=4). The intervention involves reimbursement, a practice audit of 100 randomly selected patients with diabetes, electronic prompts targeting professionals, GP-endorsed reminders (face-to-face, phone and letter), and a patient information leaflet. Eligible patients had type 1 or type 2 diabetes and not attended DRS. Intervention practices delivered the intervention between July 2019 and January 2020. The intervention is currently being delivered in wait-list control practices. Data were collected during research phone calls with practices, to understand intervention delivery (fidelity, feasibility) and research processes. Semi-structured interviews are ongoing with a purposive sample of staff and patients to examine intervention acceptability and feasibility.

Findings

Sixty practices expressed an interest in the study. Across intervention practices, at baseline 22-30% of patients had not attended DRS. Preliminary analysis indicates that the intervention was feasible, albeit there were delays to the audit and prompts due to limited access to Excel, and limited experience in audit or adding prompts. In terms of fidelity, practices varied in the sequence or content of reminders: phone calls were conducted after letters (n=1); reminder letter prepared by the practice were used in lieu of the study template (n=1).

Consequences

The IDEAs intervention appears to be feasible in GP, though practices may need more specific training in the use of software to support audits. Findings will be used to refine the intervention and study procedures. A definitive trial will determine whether IDEAs is a cost-effective intervention to improve DRS uptake.