Uptake of and adherence to diabetic retinopathy screening in an opportunistic setting: a quasi-experimental cohort study from Upper Austria

Introduction Diabetic retinopathy (DR) is a leading cause of preventable vision impairment among working-age adults and regular screening is key to early detection and intervention. Unlike countries with organised national screening pathways, Austria relies on opportunistic screening. This study examines screening uptake following diabetes diagnosis, assesses the contribution of a diabetes-specific Disease Management Programme (DMP) and evaluates whether a more systematic regional model may better close existing care gaps.Method We conducted a retrospective cohort study using pseudonymised administrative claims data from the Austrian Health Insurance Fund in Upper Austria (AHIF-UA), which included 53 500 patients with diabetes. To estimate the effect of a diabetes diagnosis on screening behaviour, we employed a quasi-experimental approach. We compared individuals first recorded with diabetes in quarter g with same-sex, same birth-year individuals first recorded 12 quarters later, observing both groups in the same calendar quarters. To evaluate the causal impact of access to the DMP, we used the quasi-random assignment of patients to primary care providers (PCPs) who either offer DMP services or did not.Findings Results indicate a statistically significant 5 percentage-point increase in eye care visits immediately following a diabetes diagnosis. However, overall adherence to recommended care was low: only 46% of individuals had an ophthalmology visit in the first year and just16.7% maintained annual visits over 3 years. Enrolment in the DMP significantly improved screening rates. Persons assigned to a PCP offering the DMP were eight times more likely to enrol in DMP, but only 1.3 times more likely to have an ophthalmology contact after their diabetes diagnosis, demonstrating access in an opportunistic model as an important but not decisive driver.Conclusion Although DMPs based on an opportunistic model improve overall adherence to screening guidelines, they do not achieve the same level of participation in retinopathy screening as systematic programmes in other countries.