Telescreening for DR has matured; consequently, CHSCs are capable of providing screening, diagnosis, management, and follow-up for diabetic eye diseases, which has greatly improved the coverage rate of people with diabetes and the accessibility of eye care services . Telescreening for DR in the communities has significant advantages in the System in Shanghai, but many challenges still exist. One of these is whether people with diabetes and CHSCs’ staff were satisfied with the System. A satisfaction survey is a handy quantitative tool for obtaining information directly from those receiving the service and providers involved in the System . Higher satisfaction of those receiving the service can improve their willingness to participate in telescreening for diabetic eye diseases again in the future, while increasing the popularity of the System. At the same time, higher satisfaction of the providers is closely related to the implementation efficiency and the long-term development of the System .
This study investigated the satisfaction of those receiving the service and providers participating in the System in Shanghai. The findings were as follows.
First, a large majority of people with DR were satisfied with telescreening for diabetic eye diseases in the community. Also, they were willing to participate in the System the following year, which was consistent with other studies that reported higher satisfaction in people with diabetes for DR telescreening [18, 21]. The overall satisfaction was significantly related to the actual experience of people with DR during the telescreening process. The convenience of telescreening, reasonable and orderly arrangement of telescreening process, and ability to improve awareness of related diseases were significantly associated with the overall satisfaction with the System among people with DR. Similar to findings in other countries, people with diabetes believed that DR telescreening, compared with traditional fundus examination, was more convenient and faster, reduced the time and cost to visit doctors, increased the understanding of their own diseases, and provided support for further clinical diagnosis and treatment [21–23].Therefore, further optimizing the process of DR telescreening, providing a spacious and neat telescreening environment, providing timely feedback of telescreening results and referral recommendations, and strengthening the training of community staff and the education on related diseases for people with DR were crucial to improve those DR patients’ satisfaction with the System.
Second, the overall satisfaction of the CHSCs’ staff with the System was not ideal. Less than half of the CHSCs’ staff were satisfied with the System, and the satisfaction of the suburban CHSCs’ staff was relatively lower. According to the present survey, nearly two fifths of the CHSCs did not provide eye care services, and this situation was especially obvious in the suburban CHSCs. Thus, weaker ophthalmic clinical competence in the suburban CHSCs caused a heavier telescreening workload, resulting in lower satisfaction with the System. Through the establishment of the System, one third of the CHSCs included the prevention and treatment of diabetic eye diseases into the services of general practitioners or family doctors, among which the CHSCs in urban areas had the highest proportion. Nearly 70% of CHSCs signed bilateral cooperation with superior medical institutions, with the highest proportion in urban areas. However, nearly half of the CHSCs’ staff complained that telescreening for diabetic eye diseases at the community level was not necessary at present considering the shortage of the manpower and medical resources, and this was significantly associated with the overall satisfaction with the System. Meanwhile, many of the CHSCs suggested to merge diabetic eye disease telescreening and management with the management of people with diabetes, physical examination for older adults, or routine outpatient clinic on the weekdays. Furthermore, several problems needed to be solved for the long-term development of the System. First, the community manpower was insufficient, especially those who could operate the telescreening equipment, particularly non-mydriatic fundus photography. Hence, opportunities and frequency of training for the CHSCs’ staff should be increased. Second, insufficient funds affected project implementation and staff motivation. Third, insufficient telescreening equipment affected the efficiency of screening. Meanwhile, it was necessary to improve the information management system of telescreening, increase the publicity of the System, and enhance the disease awareness of community residents. Superior medical institutions should improve the speed of remote reading feedback and set up a referral clinic for people needing further diagnosis and treatment for DR, so as to improve compliance and satisfaction with a referral. Furthermore, personalized risk-based screening schedules should be examined to optimize workload and sojourn time in telescreening programs for diabetic eye diseases [24, 25].
This is the first time to investigate the satisfaction of those receiving the service and the providers with the telescreening for DR in the communities. The participants including the people with VTDR and CHSCs’ staff were recruited from all the communities in Shanghai, and this could better reflect the majority and diversity. Nevertheless, the present study had several limitations. All participants who receiving the service were diagnosed with VTDR, lack of a control group (with mild diabetic retinopathy or no apparent retinopathy), may limit the applicability of the findings. Moreover, the satisfaction with the System need to recall, but it could lead to inaccurate results owing to poor memory.