Harvey J N, Craney L, Nagendran S, Ng C S
Endocrinology and Metabolism, University of Wales College of Medicine, Wrexham Academic Unit, Maelor Hospital, Wrexham, UK.
J Med Screen. 2006;13(2):87-92. doi: 10.1258/096914106777589669.
To examine whether population-based retinopathy screening using a central diabetes register and employing various screening methods can achieve a high degree of population coverage to meet National Screening Committee (NSC) targets. To identify the main barriers to achieving comprehensive population coverage. To analyse referrals to ophthalmology and their outcome as a measure of previously unmet need. To assess the influence of modality of screening.
Three local health board areas in North Wales.
Establishment of a district diabetes register to hold records of all patients and subserve call-recall of general practitioner (GP) sole-care patients for screening by optometrists or digital photography. Hospital attenders were screened in diabetic clinic by direct ophthalmoscopy. Data were collected for years 1 and 2 of operation of the scheme.
The system held a screening record for 86% of diabetic patients after year 1 and 93% after year 2. Failure to attend was the major barrier to comprehensive population screening, but this improved in year 2 (P<0.001). Both optometrists and photography identified substantial unmet need: 1% of all GP sole-care patients required immediate laser treatment. Photography was more sensitive than optometrist screening, but the additional retinopathy identified was mostly minor not requiring treatment.
Lack of screening is much more important than modality of screening as a cause of missed sight-threatening retinopathy. A central, district-based patient register system identifies those patients not screened for further follow-up and can produce a high level of population coverage, close to NSC targets. Such schemes are needed, particularly to support primary care diabetes management.
探讨利用中央糖尿病登记系统并采用多种筛查方法进行基于人群的视网膜病变筛查，能否实现较高的人群覆盖率以达到国家筛查委员会（NSC）的目标。确定实现全面人群覆盖的主要障碍。分析眼科转诊情况及其结果，以此作为衡量此前未满足需求的指标。评估筛查方式的影响。
北威尔士的三个地方卫生委员会辖区。
建立一个地区糖尿病登记系统，记录所有患者的信息，并为验光师或数码摄影筛查全科医生（GP）单独诊疗的患者提供召回服务。在糖尿病诊所，通过直接检眼镜对前来就诊的患者进行筛查。收集该计划实施第1年和第2年的数据。
该系统在第1年后为86%的糖尿病患者保留了筛查记录，第2年后为93%。未就诊是全面人群筛查的主要障碍，但在第2年有所改善（P<0.001）。验光师和摄影筛查均发现了大量未满足的需求：所有GP单独诊疗的患者中有1%需要立即进行激光治疗。摄影筛查比验光师筛查更敏感，但额外发现的视网膜病变大多较轻，无需治疗。
作为导致威胁视力的视网膜病变漏诊的原因，筛查不足比筛查方式更为重要。基于地区的中央患者登记系统能够识别未接受筛查的患者以便进一步随访，并可实现较高的人群覆盖率，接近NSC的目标。需要这样的计划，特别是用于支持初级保健中的糖尿病管理。
