Improvement of early detection of diabetic retinopathy - A primary care intervention study

Background: Annual screening for diabetic retinopathy is highly recommended. The early detection of background retinopathy and laser treatment can prevent most of the diabetes related blindness. However patient compliance is relatively low. Aim: We aimed to raise the performance of annual fundus examination among diabetic patients, and to evaluate the rate of undetected severe diabetic retinipathy. Methods: The study took place in an urban primary care clinic located in an average socio-economic neighborhood. The intervention program was based on implementation by the clinic staff with no additional external resources. The program included: locating the diabetic population, extending telephone invitation, and establishing cooperation with ophthalmologists. Results: In 2000, the year prior to the intervention, 42% (177/420) of our diabetic patients had a fundus examination. In 2001 the rate increased to 76% (318/420), an increase of 80%. In 17% (55/318) of the patients the ophthalmologic examination was positive, including 33 cases of background retinopathy. Patients with retinopathy had a significantly higher HbA ₁c levels and hypertension was more common. Twenty cases had an early diabetic retinopathy, while the other 13 were immediately sent for laser treatment. In the laser treatment group, the male to female ratio was almost double (69% vs. 35%, p = 0.06). Diabetes duration was longer (15.6+4.9 years vs. 8.4+5.6, p<0.001) and they had a significantly higher rate of diabetic foot and peripheral vascular disease. Conclusion: An intervention that involved primary care clinic staff without external resources increased compliance with annual fundus examination and detected diabetic retinopathy in a preventable stage.