Diabetic retinopathy screening in Australian general practice: persistently low uptake despite national guidelines...

To examine the geographic and demographic variability in diabetic retinopathy (DR) screening uptake in Australian general practice (GP) and assess factors influencing screening disparities.

A retrospective, population-based observational study was conducted using Medical Benefits Schedule (MBS) claims data for DR screening using non-mydriatic fundus cameras, under items 12,325 and 12,326 from 2016 to 2024 across Australia. MBS data was obtained from Services Australia and the demographic and socioeconomic indicators from the Australian Bureau of Statistics (ABS). Screening uptake was stratified by state, age, gender, and socioeconomic indicators. The association between screening uptake and sociodemographic factors was assessed.

A total of 15,817 DR screenings were conducted under the two MBS items, representing only 1.2% of Australia's estimated diabetic population, highlighting a substantial unmet need. New South Wales and Western Australia had the highest total screening, while Tasmania recorded the lowest uptake. Screening uptake was highest in the < 25 age group (due to statistical inflation from low diabetes prevalence) and lowest in those aged ≥ 75 years. he COVID-19 pandemic contributed to a significant decline in screening uptake during 2020-2022, with partial recovery in 2023-2024. DR screening uptake showed no significant association with socio-demographic factors.

Despite national guidelines, GP-led DR screening uptake remains low, with substantial geographic, demographic and temporal disparities in Australian general practice settings. Addressing systemic barriers, strengthening GP-led screening, and implementing targeted interventions are crucial for improving DR screening uptake in Australia. The inability to calculate per-capita screening among Aboriginal and Torres Strait Islander populations due to data limitations restricts equity analysis; future studies should address this gap.