An Innovative Australian Outreach Model of Diabetic Retinopathy Screening in Remote Communities

Abstract

Background. Up to 98% of visual loss secondary to diabetic retinopathy (DR) can be prevented with early detection and treatment. Despite this, less than 50% of Australian and American diabetics receive appropriate screening. Diabetic patients living in rural and remote communities are further disadvantaged by limited access to ophthalmology services. Research Design and Methods. DR screening using a nonmydriatic fundal camera was performed as part of a multidisciplinary diabetes service already visiting remote communities. Images were onforwarded to a distant general practitioner who identified and graded retinopathy, with screen-positive patients referred to ophthalmology. This retrospective, descriptive study aims to compare the proportion of remote diabetic patients receiving appropriate DR screening prior to and following implementation of the service. Results. Of the 141 patients in 11 communities who underwent DR screening, 16.3% had received appropriate DR screening prior to the implementation of the service. In addition, 36.2% of patients had never been screened. Following the introduction of the service, 66.3% of patients underwent appropriate DR screening (p = 0.00025). Conclusion. This innovative model has greatly improved accessibility to DR screening in remote communities, thereby reducing preventable blindness. It provides a holistic, locally appropriate diabetes service and utilises existing infrastructure and health workforce more efficiently.

Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples

“…A smaller scale study conducted in Australia evaluated the effectiveness of a team travelling to conduct diabetic retinopathy screening in remote communities. In this case, a general practitioner identified and graded the diabetic retinopathy [12]. Other telemedicine programmes have been developed to identify and refer clients with diabetic retinopathy in Canada and other countries [2,13].…”

“…A few studies have evaluated the ability of other health professionals to screen for diabetic retinopathy screening [12,13]. For example, a team from Australia travelled to 11 remote communities to conduct fundus screening.…”

“…The images were forwarded to and analysed by a general practitioner who was accredited to perform diabetic retinopathy identification and grading. Findings from this study found that this model of care significantly improved access to diabetic retinopathy screening in remote communities [12]. Similarly, in Flinders Australia, a study examined the quality assurance of using an ophthalmic nurse practitioner (NP) with special training in ophthalmic disease to screen patients for diabetic retinopathy in a local ophthalmology clinic.…”

Impact of an integrated diabetes service involving specialist outreach and primary health care on risk factors for micro‐ and macrovascular diabetes complications in remote Indigenous communities in Australia

“…Surgical outreach services to remote Indigenous communities in Australia have been shown to improve access to specialist consultations and procedures and have been associated with a reduced rate of procedures needing hospital admission . Outreach services for diabetic retinopathy screening in remote Australian communities have also been shown to improve accessibility to retinal screening and reduce the risk of preventable blindness . Improved health outcomes and greater efficiency within services have been demonstrated when specialist outreach services are part of a multifaceted intervention, involving collaboration with primary health care and other relevant health services …”

“…Outreach services for diabetic retinopathy screening in remote Australian communities have also been shown to improve accessibility to retinal screening and reduce the risk of preventable blindness . Improved health outcomes and greater efficiency within services have been demonstrated when specialist outreach services are part of a multifaceted intervention, involving collaboration with primary health care and other relevant health services …”