Implantación del cribado de retinopatía diabética mediante retinografía digital en atención primaria / Implementation of diabetic retinopathy screening using digital retinography in primary care

Objetivo: Mejorar la detección precoz y el seguimiento de la retinopatía diabética (RD) en 2 centros de salud mediante retinografía no midriática (RNM). Diseño: Estudio descriptivo longitudinal prospectivo. Emplazamiento: Área 11 de atención primaria (AP) de Madrid. Participantes: Pacientes diabéticos adultos (DM) sin exploración de fondo de ojo (FO) en los 2 últimos años. Intervenciones: Proceso de implantación del cribado de RD mediante RNM en AP. Fotografía digital de la retina efectuada por personal de enfermería. Interpretación de retinografías por el oftalmólogo. Mediciones: Número de DM con FO. Número de pacientes con RD. Grado de control metabólico en los últimos 2 años (HbA1c). Periodo de estudio: Septiembre de 2009 a septiembre de 2011. Resultados: El número de DM aumentó de 2.850 a 3.357. La proporción de pacientes con FO ascendió del 6,7% (IC 95%: 5,7-7,6%) al 32,4% (IC 95%: 30,8-34,0%) (p<0,001). La prevalencia de RD aumentó de 3,85% (IC 95%: 3,14-4,58%) a 4,3% (IC 95%: 3,59-4,99%). El porcentaje de pacientes con FO y RD disminuyó del 60% (IC 95%: 52,77-67,23%) al 14% (IC 95%: 11,87-16,09%) (p<0,001). La proporción de DM con HbA1c aumentó del 21,9% (IC 95%: 20,36-23,43%) al 52,4% (IC 95%: 50,69-54,10%) (p<0,001). El valor medio de HbA1c en pacientes con RD fue 7,8 (IC 95%: 7,50-8,06) y sin RD, 7,1 (IC 95%: 7,08-7,22) (p<0,001). Conclusiones: La RNM en AP se acompaña de un incremento del número de diabéticos con exploración de FO. Es posible implementar el cribado de RD mediante RNM si se dispone de los recursos necesarios, de la motivación de los profesionales implicados y del compromiso directivo. Un seguimiento más prolongado permitirá conocer su impacto en la tasa de interconsultas a oftalmología, llegando a derivar solo las imágenes dudosas(AU)

Objective: To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC). Design: Prospective longitudinal descriptive study. Location: Area 11 Primary Care, Madrid. Participants: Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO). Interventions: Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist. Measurements: Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c). Study period: September 2009-September 2011. Results: DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<0.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001).The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<0.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<0.001), respectively. Conclusions: NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images(AU)

[Implementation of diabetic retinopathy screening using digital retinography in primary care]. / Implantación del cribado de retinopatía diabética mediante retinografía digital en atención primaria.

OBJECTIVE: To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC). DESIGN: Prospective longitudinal descriptive study. LOCATION: Area 11 Primary Care, Madrid. PARTICIPANTS: Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO). INTERVENTIONS: Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist. MEASUREMENTS: Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c). STUDY PERIOD: September 2009-September 2011. RESULTS: DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001). The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<.001), respectively. CONCLUSIONS: NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images.