Objective: To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes.
Design: Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs).
Setting and participants: 1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005.
Main outcome measures: Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage.
Results: Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months.
Conclusions: Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.
- 1. De Courten M, Hodge A, Dowse G, et al. Review of the epidemiology, aetiology, pathogenesis and preventability of diabetes in Aboriginal and Torres Strait Islander populations. Canberra: AGPS, 1998.
- 2. Dwyer J, Silburn K, Willson G. National Strategies for Improving Indigenous Health and Health Care. Canberra: Australian Government Department of Health and Ageing, 2004. Available at: http://www.health.gov.au/oatsih/phc (accessed Mar 2005).
- 3. Australian Institute of Health and Welfare. Expenditures on health services for Aboriginal and Torres Strait Islander people 1998–99. Canberra: AIHW and Commonwealth Department of Health and Aged Care, 2001. (AIHW Catalogue No. AIHW 7). Available at: http://www.aihw.gov.au/publications/ihw/ehsatsip98-99/ (accessed Feb 2005).
- 4. Mak DB, Plant AJ, McAllister I. Screening for diabetic retinopathy in remote Australia: a program description and evaluation of a devolved model. Aust J Rural Health 2003; 11: 224-230.
- 5. Karagiannis A, Newland HS. Mobile retinal photography: a means of screening for diabetic retinopathy in Aboriginal communities. Aust N Z J Ophthalmol 1996; 24: 333-337.
- 6. Diamond JP, McKinnon M, Barry C, et al. Non-mydriatic fundus photography: a viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia? Aust N Z J Ophthalmol 1998; 26: 109-115.
- 7. National Aboriginal and Torres Strait Islander Eye Health Program. Canberra: Australian Government Department of Health and Ageing. Available at: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-eyehealth-index.htm (accessed Feb 2005).
- 8. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology 1991; 98 (5 Suppl): 823-833.
- 9. SPSS Inc. SPSS version 6.1.3 Chicago Ill: SPSS Inc.
- 10. Jaross N, Ryan P, Newland H. Prevalence of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 1. Clin Experiment Ophthalmol 2003; 31: 6-7.
- 11. Tapp RJ, Shaw JE, Harper CA. The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003; 26: 1731-1737.
- 12. McKay R, McCarty CA, Taylor HR. Diabetic retinopathy in Victoria, Australia: the Visual Impairment Project. Br J Ophthalmol 2000; 84: 865-870.
- 13. Maberley D, Morris A, Hay D, et al. A comparison of digital retinal image quality among photographers with different levels of training using a non-mydriatic fundus camera. Ophthalmic Epidemiol 2004; 11: 191-197.
- 14. Kaur H, Maberley D, Chang A, Hay D. The current status of diabetes care, diabetic retinopathy screening and eye-care in British Columbia’s First National Communities. Int J Circumpolar Health 2004; 63: 277-285.
- 15. Tapp JR, Zimmet PZ, Harper CA, et al. Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care 2004; 27: 688-693.
- 16. Brechner RJ, Cowie CC, Howie LJ, et al. Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA 1994; 27: 1714-1718.
- 17. Wilson A, Baker R, Thomson J, Grimshaw G. Coverage in screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales. Diabetes Med 2004; 21: 271-278.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.