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

Ibanez-Bruron, MC; Solebo, AL; Cumberland, PM; Rahi, JS; Diabetic Eye Disease in Childhood Study (DECS) group; (2019) Vulnerabilities in diabetic eye screening for children and young people in England. Pediatric Diabetes , 20 (7) pp. 932-940. 10.1111/pedi.12887. Green open access

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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 counselling 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. This article is protected by copyright. All rights reserved.

Type: Article
Title: Vulnerabilities in diabetic eye screening for children and young people in England
Location: Denmark
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/pedi.12887
Publisher version: https://doi.org/10.1111/pedi.12887
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Child Care, Diabetic Retinopathy, Integrated Health Care Systems, Ophthalmology, Screening Programs
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10077524
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