Faculty Advisor

Diana Dedmon, DNP, APRN, FNP-BC

Document Type


Publication Date

Spring 4-27-2022


Analytical, Diagnostic and Therapeutic Techniques and Equipment | Diseases | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Eye Diseases | Family Medicine | Family Practice Nursing | Health and Medical Administration | Health Services Administration | Health Services Research | Investigative Techniques | Medicine and Health Sciences | Nursing | Ophthalmology


Purpose/Background Diabetic retinopathy (DR) is the leading cause of blindness in adults. Current guidelines recommend that all patients with type 2 diabetes mellitus (T2DM) have a DR screening (DRS) upon diagnosis of T2DM and then annually, but the adherence rate is only approximately 60%. This scoping review aims to evaluate the effectiveness of primary care providers (PCPs) employing strategies to increase compliance with annual DRS among adult patients with T2DM.

Methods Between September 2021 and January 2022, a literature review was performed to collect studies evaluating interventions to increase adherence to DRS. Individual searches of PubMed, SCOPUS, and CINAHL were completed using MeSh with the following keywords: diabetic retinopathies, primary healthcare, diabetic retinopathy screening, and others. 15 articles were potentially appropriate, then a rapid critical appraisal and in-depth discussion of these articles yielded a final selection of 7 articles. The goal was to demonstrate that interventions implemented by PCPs can increase adherence to DRS.

Results The articles included consisted of 4 randomized controlled trials, 2 clinical trials, and 1 systematic review. Per the articles, the most effective methods to increase the rate of DRS are behavior change techniques, improving general T2DM care, providing evidence-based informational leaflets about DR to patients, incorporating DRS into primary care appointments, and adding a point-of-care reminder to the electronic medical record. Interventions that did not improve adherence were financial incentives and printed reminders to the PCPs.

Implications for Nursing Practice The results of this scoping review highlight the difficulty of increasing the rate at which PCPs remind patients to screen for DR and increasing attendance of patients to DRS. Promising results indicate that interventions can be implemented to encourage improvement. PCPs can have a significant positive impact on the rate of patients developing DR, and this finding suggests that more research on the topic is valuable.