Patients' perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities
Patients' perspectives on the barriers to referral after telescreening for diabetic retinopathy in communities
复制标题
患者对社区糖尿病视网膜病变远程筛查后转诊障碍的看法
DOI：
10.1136/bmjdrc-2019-000970
复制
发表时间：
2020-01-01
影响因子：
4.1
通讯作者：
Zou, Haidong
中科院分区：
文献类型：
--
作者：
Zhu, Xiaofeng;Xu, Yi;Zou, Haidong
目的了解糖尿病视网膜病变(DR)患者电筛治疗后转诊完成情况，探讨相关转诊障碍。研究设计与方法对社区所有接受DR电筛治疗的患者进行自填式问卷调查，以评估转诊完成情况及对转诊障碍的看法。通过单因素分析和多元Logistic回归模型，确定与不完全转诊相关的社会人口学特征和知觉障碍。结果在3362名参与者中，46.1%的人有不完全转诊。高龄和低教育水平与不完全转诊显著相关。几乎所有参与者在转诊过程中都至少有一个障碍。与知识和态度相关的障碍，包括“年龄太大不想再接受治疗”、“来不及转诊”、“目前没有需要治疗的大病”、“我的眼睛还好”、“不信任推荐的医院”和“以前没有得到过诊断或治疗”，以及与物流相关的障碍“行动不便或交通困难”与不完全转诊显著相关。结论DR电筛后的不完全转诊问题在VTDR患者中较为严重，尤其是在年龄较大和低文化程度人群中。在预测不完全转诊时，知识相关因素和态度相关因素的负性可能比逻辑障碍更显著。因此，改善转诊依从性的新战略有助于优化转诊的可及性，并持续提供教育支持，以提高对疾病的认识，增加医患沟通的有效性。
ObjectiveTo understand the referral completion and explore the associated barriers to the referral after telescreening for diabetic retinopathy (DR) among people with vision-threatening DR (VTDR).Research design and methodsAll participants with VTDR after DR telescreening in the communities completed the self-reported questionnaires to assess referral completion and their perspectives on referral barriers. Sociodemographic characteristics and perceived barriers related to incomplete referrals were identified by conducting univariate analysis and multiple logistic regression model. The final model was then built to predict incomplete referral.ResultsOf the 3362 participants, 46.1% had incomplete referral. Old age and lower education level showed significant association with incomplete referral. Almost all participants had at least one barrier during the referral process. Knowledge-related and attitude-related barriers, including 'Too old to want any more treatment', 'Difficulty in getting time to referral', 'No serious illness requiring treatment at present', 'My eyes are okay', 'Distrust the recommended hospital' and 'Have not been diagnosed or treated before', and logistics-related barrier 'Mobility or transportation difficulties' showed significant association with incomplete referral.ConclusionsThe issue of incomplete referral after DR telescreening is serious among individuals with VTDR, particularly in the elder and low education level population. The negativity of knowledge-related and attitude-related factors might be more prominent than logistic barriers in predicting incomplete referral. Therefore, new strategies to improve the compliance with referral assist in optimizing the referral accessibility, and the ongoing educational support to improve the awareness of disease and increase the effectiveness of physician-patient communication.