scholarly journals Barriers and facilitators to diabetic retinopathy screening within Australian primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthew J. G. Watson ◽  
Peter J. McCluskey ◽  
John R. Grigg ◽  
Yogesan Kanagasingam ◽  
Judith Daire ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Urban Areas ◽  
Ecological Model ◽  
Continuing Professional Development ◽  
Structured Interview ◽  
System Level ◽  
Retinal Screening ◽  
General Practices ◽  
Retinal Photography

Abstract Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices.

scholarly journals A 15 Month Experience with a Primary Care-based Telemedicine Screening Program for Diabetic Retinopathy.

2020 ◽  
Author(s):  
James Benjamin ◽  
Justin Sun ◽  
Devon Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
University Hospital ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions: Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

Screening for Diabetic Retinopathy in Primary Care: Retinal Photography Alone can Be Used Efficiently and Effectively to Exclude Those with Sight Threatening Lesions

1997 ◽  
Vol 4 (3) ◽  
pp. 174-176 ◽  
Author(s):  
P M S Evans ◽  
T S Purewal ◽  
A Hopper ◽  
H Slater ◽  
D R L Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Gold Standard ◽  
Detection Rate ◽  
False Positive Rate ◽  
Poor Quality ◽  
Background Retinopathy ◽  
Screening Performance ◽  
Positive Rate ◽  
Retinal Photography

Background— Good screening performance of retinal photography and ophthalmoscopy together in screening for diabetic retinopathy in primary care have been reported. This study reanalysed the data to evaluate the screening performance of photography alone. Methods— One thousand and ten patients screened by fundal photography and ophthalmoscopy were studied retrospectively. Fundal photographs were quality graded with poor quality pictures being excluded from the analysis. Each patient was reviewed initially by both retinal photographs and ophthalmoscopy by an ophthalmologist, the “gold standard”. Six months later the fundal photographs were reviewed and reported in a blinded manner by the ophthalmologist. Results— Two thousand and fourteen photographs were obtained, of which 162 (8%) had to be excluded because of poor quality. On review of the remaining 18S2 photographs in isolation, of 77 cases of severe retinopathy as determined by the “gold standard”, 67 had severe changes on photography—detection rate 87%. Of the 1775 cases without sight threatening retinopathy only five were judged to have sight threatening changes on photography—false positive rate 0.3%. Considering sight threatening and background retinopathy together, the detection rate was 69% (2S7 of 375) and the false positive rate 1.6% (23 of 1477). Conclusion— Good quality fundal photographs alone seem specific enough to screen for sight threatening diabetic retinopathy, but will underdetect background retinopathy.

scholarly journals Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care

BMJ ◽  
1996 ◽  
Vol 312 (7032) ◽  
pp. 679-682 ◽  
Author(s):  
J P O'Hare ◽  
A Hopper ◽  
C Madhaven ◽  
M Charny ◽  
T S Purewal ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Prospective Study ◽  
A Prospective Study ◽  
Retinal Photography

scholarly journals A 15 month experience with a primary care-based telemedicine screening program for diabetic retinopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
James E. Benjamin ◽  
Justin Sun ◽  
Devin Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
Cost Effective ◽  
University Hospital ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment. Methods This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated. Results Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis. Conclusions Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy and other ophthalmic conditions is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

Innovative mobile-health led Participatory Approach to Comprehensive Screening and Treatment of Diabetes (IMPACT Diabetes): Rationale, Design and Baseline Characteristics (Preprint)

2021 ◽  
Author(s):  
Abhinav Bassi ◽  
Sumaiya Arfin ◽  
Oommen John ◽  
Devarsetty Praveen ◽  
Varun Arora ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Glucose ◽  
Community Health ◽  
Community Health Workers ◽  
Urban Areas ◽  
Primary Care Physicians ◽  
Health Workers ◽  
System Level ◽  
Elevated Blood

BACKGROUND India has 66 million people with diabetes, of which a large proportion do not receive adequate care. The Primary Health Centres across rural and urban areas serve as platforms for continuum of care and early detection of diabetes in the population. The untapped potential of frontline health care workforce can act as a means to bridge the gaps of service demands. OBJECTIVE We aim to develop and evaluate a technology-enabled system-level intervention based around the community health workers [Accredited Social Health Activists (ASHA)] and primary-care physicians, and mobile tablet-based clinical decision support system to improve the identification and management of individuals with diabetes and cardiovascular disease (CVD) in primary care settings in India. METHODS A cluster-randomized trial in sixteen villages/peri-urban areas in Andhra Pradesh and Haryana will test the preliminary effectiveness of this intervention. An independent evaluation will compare the difference in the proportion of participants with diabetes having a 0.5% reduction in HBA1c (measured at baseline and end-line) in intervention and usual-care arm. Qualitative interviews of physicians, ASHA, and community members will ascertain the intervention acceptability and feasibility. RESULTS A total of 1785 adults over 30 years (females: 53.2%; median age: 50 years) were screened. ASHAs achieved 100% completeness of data for all anthropometric, blood-pressure, and blood-glucose measures. At baseline, 63% of the participants were overweight/obese, 27.8% had elevated blood-pressure, 20.3% were at high-risk for CVD, and 21.3% had elevated blood-glucose. Half of the individuals with diabetes were newly diagnosed. CONCLUSIONS Transfers of simple clinical procedures from physicians to non-physician health workers, with the help of technology, can support the provision of healthcare in under-served communities. The preliminary findings suggest that community health workers can successfully screen and refer patients with diabetes and/or CVD to physicians in the Indian primary healthcare system. The proposed model can be adapted for larger trial sand tested for other commonly prevalent disease conditions. CLINICALTRIAL REF/2016/05/011275

scholarly journals General practice ethnicity data: evaluation of a tool

2014 ◽  
Vol 6 (1) ◽  
pp. 49 ◽  
Author(s):  
Pat Neuwelt ◽  
Sue Crengle ◽  
Donna Cormack ◽  
Melissa McLeod ◽  
Dale Bramley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
New Zealand ◽  
Data Collection ◽  
System Level ◽  
Inductive Method ◽  
Health Board ◽  
District Health ◽  
General Practices ◽  
Ethnicity Data

INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT) in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed. KEYWORDS: Data collection; ethnicity; general practice; primary health care

scholarly journals A 15 Month Experience with a Primary Care-based Telemedicine Screening Program for Diabetic Retinopathy

2020 ◽  
Author(s):  
James Benjamin ◽  
Justin Sun ◽  
Devon Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
University Hospital ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted screenings actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

scholarly journals Like using a refrigerator to heat food: capacity and capability funding in primary care and the legacy of the Primary Health Organisation Performance Programme

2020 ◽  
Vol 12 (4) ◽  
pp. 345 ◽  
Author(s):  
Reuben Olugbenga Ayeleke ◽  
Timothy Tenbensel ◽  
Pushkar Raj Silwal ◽  
Lisa Walton
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Performance Management ◽  
Policy Development ◽  
Health Sector ◽  
System Level ◽  
Structured Interviews ◽  
Key Issues ◽  
General Practices ◽  
Care Improvement

ABSTRACT INTRODUCTIONIn 2016, the New Zealand Ministry of Health introduced the System Level Measures (SLM) framework as a new approach to health system improvement that emphasised quality improvement and integration. A funding stream that was a legacy of past primary care performance management was repurposed as ‘capacity and capability’ funding to support the implementation of the SLM framework. AIMThis study explored how the capacity and capability funding has been used and the issues and challenges that have arisen from the funding implementation. METHODSSemi-structured interviews with 50 key informants from 18 of New Zealand’s 20 health districts were conducted. Interview transcripts were coded using thematic analysis. RESULTSThe capacity and capability funding was used in three different ways. Approximately one-third of districts used it to actively support quality improvement and integration initiatives. Another one-third tweaked existing performance incentive schemes and in the remaining one-third, the funding was passed directly on to general practices without strings attached. Three key issues were identified related to implementation of the capacity and capability funding: lack of clear guidance regarding the use of the funding; funding perceived as a barrier to integration; and funding seen as insufficient for intended purposes. DISCUSSIONThe capacity and capability funding was intended to support collaborative integration and quality improvement between health sector organisations at the district level. However, there is a mismatch between the purpose of the capacity and capability funding and its use in practice, which is primarily a product of incremental and inconsistent policy development regarding primary care improvement.

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