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PRIMARY CARE: Trisha Greenhalgh Barriers to concordance with antidiabetic drugs—cultural differences or human nature? BMJ 2005; 330: 1250 [Full text]

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Discordance among Screening detected Diabetics to attend a Diabetic Retinopathy Screening Camp.

Tarun Sharma, Swati Agarwal, Pradeep G Paul,Sheshadri Mahajan, Padmaja Kumari Rani, Rajiv Raman , Govindasamy Kumaramanickavel, Tarun Sharma   (13 May 2005)

Discordance among Screening detected Diabetics to attend a Diabetic Retinopathy Screening Camp. 13 May 2005
Tarun Sharma, Director, Shri Bhagwan Mahavir Vitreoretinal services Sankara Nethralaya , 18 College road,Chennai - 600006., Swati Agarwal, Pradeep G Paul,Sheshadri Mahajan, Padmaja Kumari Rani, Rajiv Raman , Govindasamy Kumaramanickavel, Tarun Sharma Send response to journal: Re: Discordance among Screening detected Diabetics to attend a Diabetic Retinopathy Screening Camp.	Diabetes and its related complications are emerging as one of the major challenges to health care providers. Many diabetics do not go through regular eye examination.1-3 This report highlights as how frequently this non-response is observed in diabetics who were examined at the rural settings. In order to detect microvascular complications of diabetes, diabetic retinopathy (DR) screening camps were organized in the rural South India. These DR camps were preceded by diabetic screening camps; all known diabetics (n=4111 patients) and newly detected provisional diabetics (random blood sugar >200 mg/dl, n=1076) were advised to attend DR screening camps for fundus evaluation, scheduled within a week. Surprisingly, only half of the known diabetics (n=2231), and one-fourth of the newly-detected provisional diabetics (n=125) attended the DR screening camps. Such a poor response could be related to poor motivation, unawareness of diabetic eye complications, fear, spirituality (faith and hope), priorities, economic or logistical factors. We advocate that along with diabetic and diabetic retinopathy screening camps, focus should also be on awareness campaign on diabetes and its related microvascular complications. This would need an integrated team involving social workers, voluntary organizations and local community leaders to participate in the awareness program. Educational programmes on diabetes related blindness should be promoted by conducting local meetings, using creatives (information leaflets, brochures), media (news paper, television) and celebration of important days such as World Diabetic Day. Reminders by telephone, postal, email and personal visit by social worker might improve the rates of delivery of clinical preventive services such as diabetic retinopathy screening.4, 5 References 1.Witkin SR, Klein R, Jensen SC: Ophthalmologic care for people with diabetes. JAMA 251:2531-34,1984. 2.Brechner RJ, Cowie CC, Howie J et al. Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA 270:1714-18,1993. 3.Will JC, German RR, Schurman E et al. Patient adherence to guidelines for diabetic eye care: Results from the Diabetic Eye Disease Follow-up Study. Am J Public Health 84:1669-1671,1994. 4.Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. NEJM 2001;345(13):965–70. 5. Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer- generated physician and patient reminders: tools to improve population adherence to selected preventive services. J Family Pract 1991;32(1):82–90 Competing interests: None declared