Interrupted diabetes eye care in Te Toka Tumai Auckland 2008-2019: analysis of routinely collected health-facility...

The aim of this study was to quantify interrupted care (delayed care and complete loss to follow-up) across the diabetes eye care pathway among people aged ≥15 years in Auckland, New Zealand, and assess disparities by age, sex, ethnicity, deprivation and diabetes duration.

We analysed data from people engaged with diabetes retinal screening in Auckland between 1 January 2008 and 31 December 2019. Follow-up continued from first appointment until death or study end. Delayed care and complete loss to follow-up were assessed at retinal screening, when referred from screening to ophthalmology with referrable diabetic retinopathy (R3 or worse), and at ophthalmology review.

Almost one-third of people experienced delays in retinal screening care beyond 24 months (n=4,471/14,708; 30.4%) and one-fifth were completely lost to follow-up (n=2,970/14,708; 20.2%). Similar proportions were observed for a delay beyond 6 months when referred from retinal screening to ophthalmology with referrable retinopathy (n=648/1,909; 33.9%) and a delay beyond 12 months between ophthalmology review (n=366/1,136; 32.2%) or complete loss to follow-up from these two stages (n=433/1,909; 22.7% and n=188/1,136; 16.5% respectively). Younger adults were more likely to experience complete loss to follow-up from retinal screening and ophthalmology review compared to people aged 50-59 years; compared to NZ Europeans, all other ethnicity groups were more likely to be lost to follow-up from retinal screening, with Māori and Pacific peoples experiencing the greatest disparity.

Loss to follow-up and delayed care were common across all stages of the diabetes care pathway assessed, with disparities by age and ethnicity.