TY - JOUR
T1 - Effectiveness of Interventions to Promote Screening for Diabetic Retinopathy
AU - Zhang, Xuanping
AU - Norris, Susan L.
AU - Saadine, Jinan
AU - Chowdhury, Farah M.
AU - Horsley, Tanya
AU - Kanjilal, Sanjat
AU - Mangione, Carol M.
AU - Buhrmann, Ralf
N1 - Funding Information:
This study was supported by the Centers for Disease Control and Prevention (CDC).
PY - 2007/10
Y1 - 2007/10
N2 - Objective: To assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes. Methods: A systematic literature search was conducted of multiple electronic bibliographic databases up to May 2005. Studies were included if interventions were used to promote screening for diabetic retinopathy in any language and with any study design. Results: Forty-eight studies (12 randomized controlled trials [RCTs], four nonrandomized studies, and 32 pre-post studies) with a total of 162,157 participants, examined a wide range of interventions, which focused on one or more of the following: (1) patients or populations, (2) providers or practices, and (3) healthcare system infrastructure and processes. Four of five RCTs focusing on patients demonstrated that interventions increased screening significantly, with relative risk ranging from 1.05 (95% confidence interval [CI]=1.01-1.08) to 2.01 (95% CI=1.48-2.73). Five RCTs with a focus on the system all demonstrated significant increases in screening with relative risk ranging from 1.12 (95% CI=1.03-1.22) to 5.56 (95% CI=2.19-14.10). Thirty-six non-RCTs, which included interventions with single or multiple foci, also generally demonstrated positive effects. Conclusions: Increasing patient awareness of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy. Further research should explore strategies for increasing the rate of retinal screening among diverse or disadvantaged populations and the economic efficiency of effective interventions in large community populations.
AB - Objective: To assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes. Methods: A systematic literature search was conducted of multiple electronic bibliographic databases up to May 2005. Studies were included if interventions were used to promote screening for diabetic retinopathy in any language and with any study design. Results: Forty-eight studies (12 randomized controlled trials [RCTs], four nonrandomized studies, and 32 pre-post studies) with a total of 162,157 participants, examined a wide range of interventions, which focused on one or more of the following: (1) patients or populations, (2) providers or practices, and (3) healthcare system infrastructure and processes. Four of five RCTs focusing on patients demonstrated that interventions increased screening significantly, with relative risk ranging from 1.05 (95% confidence interval [CI]=1.01-1.08) to 2.01 (95% CI=1.48-2.73). Five RCTs with a focus on the system all demonstrated significant increases in screening with relative risk ranging from 1.12 (95% CI=1.03-1.22) to 5.56 (95% CI=2.19-14.10). Thirty-six non-RCTs, which included interventions with single or multiple foci, also generally demonstrated positive effects. Conclusions: Increasing patient awareness of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy. Further research should explore strategies for increasing the rate of retinal screening among diverse or disadvantaged populations and the economic efficiency of effective interventions in large community populations.
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U2 - 10.1016/j.amepre.2007.05.002
DO - 10.1016/j.amepre.2007.05.002
M3 - Review article
C2 - 17888859
AN - SCOPUS:34548697766
SN - 0749-3797
VL - 33
SP - 318
EP - 335
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 4
ER -