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Keeping an eye on care

ImpAct bottom lines
Why was the initiative launched?
What was done?
Is it working?
Tips for success
To find out more contact
Managing the quality of the diabetes care in Shropshire

ImpAct bottom lines




Why was the initiative launched?


Arrangements for annual eye screening of patients with diabetes are a proven element of effective care. Failure to detect diabetic retinopathy is one of the leading causes of blindness in the working population of industrialised countries. Diabetes is a very common condition affecting a significant proportion (about 2%) of the population. Progression of diabetic retinopathy in its early stages can be halted by laser treatment - but to be effective it must be given at the earliest opportunity.

In 1995, there was no uniform or comprehensive screening programme for the detection of diabetic retinopathy in Shropshire. A pilot programme, funded by the health authority, was launched in January 1996 to remedy this deficiency.

What was done?


The programme was designed to tackle the challenge of providing a screening service in a pre-dominantly rural area. The absence of a diabetes register and the lack of specialised training of optometrists were two compounding factors.

The programme had two main components - one tackled services in the community and the other focused on patients who attend hospital clinics. Initially a working group was set up involving optometrists, a consultant ophthalmologist, consultant diabetologists and colleagues from the health authority. As the project progressed clinical staff working in the hospital's Diabetes Eye Screening Department were also involved.




Creation of a training course for optometrists and agreement of a referral protocol were essential first steps for the introduction of a community based screening programme. All NHS registered optometrists practising in Shropshire have since been invited to enrol for the programme. This involves attending an initial training course at the local hospital, agreeing to adhere to the referral protocol and attending yearly updating sessions.

Once enrolled the optometrist is entitled to examine diabetic patients referred by a local GP and is paid a fee for each patient screened. The protocol requires that the patient's eyes be dilated prior to examination. GPs, in consultation with patients, choose the optometrist to whom the patient should be referred.

Within the two hospitals providing the Shropshire Diabetes Service, arrangements were introduced to ensure that all patients who attend Diabetic Clinics have their eyes photographed by the diabetes eye screening practitioners. The photographs are reviewed by the consultant diabetologists and ophthalmoscopic examinations are undertaken.

The information collected through the screening programme has been assembled to provide a database of patients. It contains basic data to identify patients, the date of diagnosis and method of diabetic control and information about screening and associated clinical examinations. Analysis of the data has proved to be very useful in managing and monitoring of the screening programme. Individual practices in the community - both GPs and Optometrists - are being kept in touch with the progress of their patients. Moreover, patients who have not been screened are being identified and followed-up.

Is it working?


Very much so - in the first three years the screening programme has reached almost 8,000 patients and about 70% of these have been rescreened. These numbers represent about 90% of the target population and about 2% of the population of Shropshire. About 10% (740) have been referred to the ophthalmologist and 20% of these patients have received laser therapy.

The programme is proving popular with patients, GPs and optometrists and the quality of screening is proving to be high. A series of postal surveys has been used to assess the response to the new approach: all of these had an encouraging high response from about 90% of those invited to take part.


Comparison of 225 patients screened by optometrists and retinal photography showed that in 10 cases (4.4%) there were minor differences reported. However none of these were significant enough to alter treatment. The programme has shown that optometrists can be trained to be expert screeners and that they can adhere to referral criteria. The screening fee is paid to optometrists after the reports are received in the hospital - this ensures that the reports are received!

Tips for success



To find out more contact

Clare Jowett
Clinical Audit Manager
Royal Shrewsbury Hospitals
NHS Trust Brett House
Shrewsbury SY3 3XF
Telephone 01743 261118
Fax 01743 261118
The following material is available:



 

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