Changes in management of diabetic retinopathy by Australian ophthalmologists as a result of the NHMRC clinical guidelines.
OBJECTIVE
To document changes in management of diabetic retinopathy by Australian ophthalmologists after release of the National Health and Medical Research Council (NHMRC) clinical guidelines.


METHODS
Self-administered questionnaires were mailed to Australian ophthalmologists prior to release of the NHMRC guidelines for the management of diabetic retinopathy, and at one and 2.5 years after release of the guidelines. The questionnaires elicited information about current management practices in relation to diabetic retinopathy


RESULTS
The response rate for the baseline and two follow-up surveys was 82%, 81%, and 80%, respectively. More than 85% of the ophthalmologists responded that the guidelines were useful in improving management, were easy to understand, and were already part of their routine clinical practice. A relatively small percentage (12%) felt that the guidelines made recommendations that were not practical or feasible. Contrary to the NHMRC guidelines, at the second follow-up survey, only 50% of the ophthalmologists said that they would almost never perform fluorescein angiography in eyes with mild non-proliferative diabetic retinopathy. The change from baseline to the second follow-up in the percentage of ophthalmologists who would perform cataract surgery after treating clinically significant macular oedema (as advised by the NHMRC guidelines) was statistically significant (baseline = 83.7%, 95% confidence limit = 80.4, 87.0; second follow up = 90.4, 95% confidence limit = 87.3, 93.5).


CONCLUSIONS
Distribution of the printed NHMRC Clinical Practice Guidelines: Management of Diabetic Retinopathy and full colour Retinopathy Chart resulted in a significant change in the recommended order of treatment of clinically significant macular oedema. However no significant change in the use of fluorescein angiography was documented.
McCarty
C A
CA
Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Australia.
Wright
S
S
McKay
R
R
Taylor
K I
KI
Keeffe
J E
JE
D001315:Australia; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000628:therapy*; D003941:Diagnostic Techniques, Ophthalmological; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000592:standards; D009885:Ophthalmology / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires