Abstract
Purpose :
Despite the appeal of retinal photography in facilitating retinal screening including incentives through Medicare Benefits Schedule (MBS) items (12325 and 12326), comprehensive diabetic retinopathy (DR) screening has not been achieved in Australia. This study aimed to identify the incentives and barriers to conducting DR screening in general practices.
Methods :
A qualitative study, involving in-depth interviews, was conducted between November 2019 and March 2020. Fifteen general practitioners (GPs) from urban and rural practices in Australia were recruited. Data were collected using a semi-structured interview guide. All interviews were conducted over the phone, and each interview lasted up to 45 minutes. Recorded data were transcribed verbatim. The thematic analysis was carried out using NVivo to organise data and classify recurrent themes.
Results :
Thirteen male and two female GPs aged 54.7±15.5 years completed the interviews. Seven participants were practising in urban areas, while eight were practising in rural areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants performed DR screening in their general practices. Only three participants were aware of the MBS items that allow GPs to bill for retinal photography and image reporting. Seven themes (a combination of incentives and barriers) emerged, namely (i) GPs awareness of MBS items; (ii) optometrists are perceived as ideal for DR screening; (iii) GPs are not competent in DR detection; (iv) costs; (v) time constraints; (vi) the need for dedicated staff to take the responsibility of DR screening; (vii) the use of artificial intelligence in DR detection.
Conclusions :
The study identified specific strategies to enable the wider implementation of DR screening in general practice, notably investing in a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency in DR detection, subsidising equipment costs, particularly for small or rural practices, and the need for a champion ace to integrate DR screening into practice workflow. Findings can guide the current clinical guidelines and policymakers to develop a better framework of key enablers that underpin the successful implementation of DR screening. Future research is needed to identify other barriers from the patients’ perspectives.
This is a 2021 ARVO Annual Meeting abstract.