Non-adherence to diabetes microvascular complications follow-up screening in the primary care population: Predictors, associated barriers, and facilitators

Abstract

Aims: We determined the rates, predictors, and barriers/facilitators of non-adherence to annual follow-up screenings for Diabetic Retinopathy (DR), nephropathy (DN) and foot complications (DFC) screening in primary care patients with type 2 diabetes.

Methods: This prospective, mixed-method, clinical study, included 934 patients (mean ± SD age 60.4 ± 9.4 years, 46.9 % women) who underwent DR/DN/DFC screenings (N = 2012 appointments). Logistic regression analysis determined the baseline predictors of non-adherence to follow-up screening (failure to attend annual follow-up screening within ± 4 months). Qualitative interviews on barriers/facilitators of screening adherence were conducted with 36/24 non-adherent/adherent patients and 9 healthcare professionals (HCPs).

Results: Non-adherence rates to DR, DFC and DN follow-up screening were 27.6 % (n = 186), 29.8 % (n = 225) and 12.7 % (n = 74), respectively. Predictors included higher total cholesterol (DR); poor self-rated Diabetes Control (DN); and higher satisfaction with diabetes support (DFC and DN). Better self-efficacy was protective (DFC). Poor HCP-patient communication and long waiting times were patient-reported barriers to adherence, while knowledge about benefits of diabetes complications screening was a facilitator. Time constraints prevented HCPs from reinforcing the importance of screening to patients.

Conclusions: Non-adherence to diabetic microvascular complications follow-up screening was suboptimal in Singapore and driven by multi-faceted predictors and barriers. Targeted interventions are needed to improve follow-up screening adherence.

Keywords: Diabetes complication; Microvascular; Predictors; Qualitative; Rates; Screening.