Newman Robert, Cummings Doyle M, Doherty Lisa, Patel Nick R
Department of Family Medicine, Brody School of Medicine, East Carolina University, NC 27834, USA.
Fam Med. 2012 Mar;44(3):159-63.
Diabetic retinopathy is the leading cause of blindness in adults in the United States, and early screening/treatment may preserve vision. This study examined the feasibility of using non-mydriatic digital retinal imaging (DRI) for retinopathy screening in a busy family medicine residency program at the point of care using a nurse-driven protocol.
We compared the number of diabetics screened during a 1-year period before and after DRI protocol implementation. We also determined the prevalence of retinopathy, assessed patient satisfaction with the alternative screening process, and tracked ophthalmologic appointment compliance for patients referred because of abnormal screening results.
Screening approximately doubled from 161 patients/year before the protocol to 330 patients/year after protocol implementation. However, DRI screening had no impact on ophthalmologic appointment compliance; only 58% of 153 patients referred for ophthalmologic evaluation because of positive screening findings completed their referral appointment. Seven cases needing urgent ophthalmologic treatment were identified. Satisfaction with primary care retinopathy screening was high.
Use of a nurse-driven protocol for digital retinal imaging at the point of care dramatically improves rates of annual retinopathy screening in academic family medicine practice and can identify patients who require subspecialty referral. However, DRI screening does not improve visit compliance rates with ophthalmologists for evaluation and management.
糖尿病视网膜病变是美国成年人失明的主要原因，早期筛查/治疗可保留视力。本研究探讨了在繁忙的家庭医学住院医师培训项目中，采用护士主导方案在即时护理点使用免散瞳数字视网膜成像（DRI）进行视网膜病变筛查的可行性。
我们比较了DRI方案实施前后1年期间筛查的糖尿病患者数量。我们还确定了视网膜病变的患病率，评估了患者对替代筛查过程的满意度，并跟踪了因筛查结果异常而转诊患者的眼科预约依从性。
筛查人数从方案实施前的每年161例患者增加到方案实施后的每年330例患者，大约增加了一倍。然而，DRI筛查对眼科预约依从性没有影响；因筛查结果呈阳性而被转诊进行眼科评估的153例患者中，只有58%完成了转诊预约。确定了7例需要紧急眼科治疗的病例。患者对初级保健视网膜病变筛查的满意度较高。
在即时护理点采用护士主导的数字视网膜成像方案可显著提高学术性家庭医学实践中每年视网膜病变筛查的比例，并可识别需要专科转诊的患者。然而，DRI筛查并不能提高患者到眼科医生处进行评估和治疗的就诊依从率。
