IMPLEMENTATION OF A SCREENING PROGRAM FOR THE EARLY DETECTION OF DIABETIC RETINOPATHY USING A NON-MYDRIATIC

CAMERA IN PRIMARY CARE

Antoni PerisCarlos Bernades

Emilia BoschSonia Burgos

Susana Vilalta

CASAP CAN BOUPISA – August 2010

Primary care services: where are we heading?Primary care services: where are we heading?

•More efficiency and quality in public health services

•Higher resolution in primary care

•Higher autonomy for professionals

•More accesibility

• Public consortia• Local and autonmic governance

(ICS – Ajuntament)

• Closeness to comunity• Sinergies

• Legal independence• Fast managing

• Public enterprise• Finance accountability• Public economic auditors

Consorci Castelldefels Agents de Salut CASAPConsorci Castelldefels Agents de Salut CASAP

•DM2 prevalence is 2-6%

•Diabetic Retinopathy (DR) is the 1st cause of blindness in Western populations (70-80% of blindness for patients from 20 to 70)

•Early diagnosis of DR can stop its development.

Diabetic RetinopathyDiabetic Retinopathy

Fundi in DM2Fundi in DM2

The guidelines recommend control of Fundi when Diagnosis and thereafter, annual control

The coverage in Catalonia is 50% of the population for the service of Ophthalmology, and the controls are every 3-4 years.

Fundi in DM2: CROCFundi in DM2: CROC

Use of non-mydriatic Ophtalmoscopy camera covers 70-100% of needed explorations.

This facilitates increasing early detection and proper treatment reducing cases of blindness

What is CROC?What is CROC?

Unit dedicated to eye screening of patients with DM2 :

• Non-mydriatic Ophtalmoscopy camera

• Air Tonometer (rule out high IOP)

• Visual acuity

What we look for in CROC?What we look for in CROC?

• The papilla

• Microaneurysms

• Hemorrhage

• Exudates (hard and soft )

• Neovascularization

• Others

CROC STRATEGIESCROC STRATEGIES

Training Professional:– 2 Family doctors in each PC Team– It consists of :

• 2 hours Theory session• 20 hours practical Fundi reading with ophtftalmologist

– Nurse aid training in other CROC team for 1 month

CROC PATHWAYSCROC PATHWAYS

– GP or Nurse programs CROC visit

– Nurse aid performs CROC

– CROC GP avaluate pictures.

– Ophtalmologists avaluates situation when in doubt

– According to the result patient is followed in CROC or

referred to Ophtalmology to avoid delays

Ophtalmologist’ referralsOphtalmologist’ referrals

• Miosi

• Cataracts

• High OIP

• Moderates NPDR

• Severes NPDR

• PDR

• Photocoagulation

Total Visits CROC Castelldefels: 1481

RESOLUTION CROC 2008RESOLUTION CROC 2008

Ophtalmologist’ referralsOphtalmologist’ referrals

•CROC avoids appointments of 1037 patients/year from Castelldefels to Ophtalmologist

•Referred patients (30% of total CROC patients) have been properly diagnosed by GP

CROC DIAGNOSTICSCROC DIAGNOSTICS

1. Nonproliferative Diabetic Retinopathy (NPDR)

1. Mild2. Moderade3. Severe

2. High IOP3. Cataract

Total: 368

DiscussionDiscussion

Pro’s:

– Ophtalmologist waiting lists are reduced

– Ophtalmologists visits only disease cases

– Primary care shows higher autonomy and resolution

capacity.

– When severe disease, pacient meets Ophtalmologist

before 48 hours.

DiscussionDiscussion

Against:

– Slight lack of coordination on Ophtalmologists reading

results (delay on avaluation both of doubts and disease)

– Purchaser is not currently paying PC Teams for CROC

activity while it goes on paying hospital as always

DiscusionDiscusion

• Population screening of diabetic retinopathy using CROC has been effective in considerably increasing photos taken and in new diagnosis of retinopathy, with respect to previous years.

• The program avoided 1037 visits to the ophthalmology service en one year. The 400 patients that were referred already had a diagnostic orientation.

cbernades @casap.cat

¡Muchas gracias!

Moltes gràcies!

Thank you very much!

Merci Beaucoup!

Muito Obrigado!

Grazie Mille!

Mulţumesc Foarte Mult!

Ezkerrik Azko!