By Dr Ben Ashby, Director of Optometry, Specsavers Australia and New Zealand.
This article appeared in mivsion July 2021 issue.
Specsavers is committed to reducing vision loss in people with diabetes by improving timely access to eyecare, collaborative patient engagement strategies, leveraging technology to support best practice care and appropriate referral.
It’s a commitment we cemented more than two years ago, including joining as a founding partner of the national diabetes eye screening program, KeepSight. We are now analysing more than 24 months of patient data to see just how much of an impact this diabetes action plan has had in improving patient outcomes.
A first look at the data
In December 2018, 4.7% of all patients presenting to Specsavers for an eye test had diagnosed diabetes. As of March 2021, this now sits at 7.8%. Looking at the data holistically over the past two years, 6.4% of all patients seen at Specsavers have been patients with diabetes. This aligns with currently reported national prevalence rates and we predict that over time this will increase as we see the measurable influence of more timely attendance for the 200,000+ patients who are now firmly part of the KeepSight care ecosystem.
Looking at the most recent data obtained, 60% of patients with diabetes seen in March 2021 were patients who had previously been seen at a Specsavers clinic – indicative of patients returning for recall within their recommended timeframes, showing the value of combined Specsavers recall and KeepSight reminders. The remaining 40% is made up of either first time attendees or those seen elsewhere by an optometrist.
Graph represents patients with diabetes attendance trends since the change to our practice management software in December 2018 to enable standard identification of patients with diabetes.
Interestingly, even though Specsavers sees a higher volume of female patients across its practices, only 5% of females presented with diabetes, compared to 8.4% of males. This aligns with Government reporting which states the prevalence of diabetes (based on self-reported data) was higher for males (5.0%) than females (3.8%)6.
Our data also aligns with previously reported studies that prevalence of diabetes increases dramatically with age7. Data shows that 1.2% of patients under 40 identified as patients with diabetes, increasing to 7.4% for those aged 40-64, and increasing further to 13.6% for those aged 65+.
In terms of geographic location, the data shows a higher prevalence of patients with diabetes in metro and regional areas (6.4% and 6.9% respectively) compared to CBD practices (2.5%), which tend to service younger patients.
Looking at the data on a state-by-state basis, it is interesting to observe the impact of COVID-19 restrictions nationally in 2020, and subsequent lockdowns in Victoria. During these times our clinics were open for urgent and essential care, and while overall patient volume dropped significantly in all states from March to May, the prevalence of patients with diabetes attending clinics remained stable, indicating the importance of access to optometric care for these patients during this time.
Recall and the impact of KeepSight
Ultimately eyecare for patients with diabetes rests on the foundation of effective and appropriate communication with this patient group. As a founding partner of KeepSight, Specsavers five-year ambition is to increase the return rate of patients with diabetes for an eye test to an ambitious 80%.
The KeepSight program, two years on, is still in its infancy and many patients are only now reaching appointment return dates. However, we are already seeing an increase in adherence to recall. While those patients under 40 have maintained a similar response pre and post-COVID-19, we have seen a lift in recall response for patients aged 40-64 and 65+, currently sitting at 34% and 42% respectively. Male and female patients with diabetes continue to respond to recall at similar rates, 29% and 28% respectively.
Overall, the return rate for patients with diabetes within recommended timeframes is nearing 40% nationally, demonstrating a growing positive adherence to recall. This is almost a 10% increase since the beginning of 2019 and speaks to the incremental momentum building through the KeepSight initiative, with this trend expected to continue in the coming 2-3 years.
The impact of diabetes related health issues in Australia should not be underestimated. It has been referred to as the ‘silent pandemic’ and will be the biggest challenge to Australia’s health system, particularly due to the additional load on the healthcare system that exists due to COVID-19.
As primary care providers, Specsavers is committed to improving health outcomes for patients with diabetes, and that means working closely with its own optometrists to embed the systems and processes whereby recall timeframes are effective, while registration and update of patient attendance onto KeepSight is second nature. It also means engaging with GPs and ophthalmologists on a consistent basis for the electronic supply, respectively, of eye reports and patient referrals via Oculo.
Utilising a coordinated approach and working side-by-side with the team at Diabetes Australia, KeepSight is already demonstrating a measurable impact on patient adherence to recall and optometry attendance rates. The positive effects of this will compound over time as patient behaviour is changed through routine recall and education.
The data collected so far from this initiative demonstrates a sustainable model for preventative eyecare for Australians living with diabetes.