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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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Family Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12875-021-01586-7 |
| _version_ | 1811226445183188992 |
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| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-12T09:25:15Z |
| format | Article |
| id | doaj.art-deb0ad8a4b36462290a30ed2974a002f |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-12T09:25:15Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-deb0ad8a4b36462290a30ed2974a002f2022-12-22T03:38:31ZengBMCBMC Family Practice1471-22962021-11-0122111010.1186/s12875-021-01586-7Barriers and facilitators to diabetic retinopathy screening within Australian primary careMatthew J. G. Watson0Peter J. McCluskey1John R. Grigg2Yogesan Kanagasingam3Judith Daire4Mohamed Estai5The Australian e-Health Research Centre, CSIROSave Sight Institute, The Faculty of Medicine and Health, The University of SydneySave Sight Institute, The Faculty of Medicine and Health, The University of SydneySchool of Medicine, University of Notre Dame AustraliaSchool of Population Health, The Faculty of Health Sciences, Curtin UniversityThe Australian e-Health Research Centre, CSIROAbstract 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.https://doi.org/10.1186/s12875-021-01586-7Diabetic retinopathyScreeningEyePhotographyDiabetesPrimary care |
| spellingShingle | 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 BMC Family Practice Diabetic retinopathy Screening Eye Photography Diabetes Primary care |
| title | 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_short | Barriers and facilitators to diabetic retinopathy screening within Australian primary care |
| title_sort | barriers and facilitators to diabetic retinopathy screening within australian primary care |
| topic | Diabetic retinopathy Screening Eye Photography Diabetes Primary care |
| url | https://doi.org/10.1186/s12875-021-01586-7 |
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