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[Implementation of diabetic retinopathy screening using digital retinography in primary care]
Lidia Clara Rodríguez García1, Alfredo Gómez de Cádiz Villarreal, Javier Pérez Rivas
1Equipo Directivo, Gerencia de Atención Primaria, Área 11 de Madrid, Madrid, España. lcrodriguez.gapm11@salud.madrid.org
Objective:
To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC).
Design:
Prospective longitudinal descriptive study.
Location:
Area 11 Primary Care, Madrid.
Participants:
Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO).
Interventions:
Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist.
Measurements:
Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c).
Study Period:
September 2009-September 2011.
Results:
DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001). The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<.001), respectively.
Conclusions:
NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images.
