A mixed-methods retrospective study: 10 years of diabetic retinopathy screening in urban Aboriginal and Torres Strait Islander primary care.

This research applies a mixed-method approach to retrospectively study the history of diabetic retinopathy (DR) screening in an urban Aboriginal and Torres Strait Islander general practice. Data from administrative practice software and publications were extracted and presented as a timeline data visualisation to staff, in six focus groups. Eighteen key staff from the Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care (CoE) were purposively recruited. The main outcome measures were retrospective administrative practice data, publications and staff interpretations regarding DR screening at the CoE. The CoE DR screening initially increased screening rates to 93%. Participants reported that CoE DR screening provides eye care from screening to treatment; all annual care is provided in one appointment; and in a client-focussed environment. From 2012 to 2016, the number of regular CoE clients with diabetes increased by 46%. Consequently, DR screening rates dropped from 44% to 22%. Participants' recognised the service could reach its full potential if it implements continuous quality improvement focussed on client experience, using rigorous data and supported by engaged staff. Initial investment in setting-up DR screening is not enough, instead ongoing quality improvement is integral to a sustainable, successful service long-term.