title: Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership.
abstract: OBJECTIVE
  To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes.
  
  
  METHODS
  Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs).
  
  
  METHODS
  1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005.
  
  
  METHODS
  Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage.
  
  
  RESULTS
  Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months.
  
  
  CONCLUSIONS
  Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.
authors.affiliation: School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia. richardm@kamsc.org.au
authors.forename: Richard B
authors.initials: RB
authors.lastname: Murray
authors.forename: Sue M
authors.initials: SM
authors.lastname: Metcalf
authors.forename: Philomena M
authors.initials: PM
authors.lastname: Lewis
authors.forename: Jacqueline K
authors.initials: JK
authors.lastname: Mein
authors.forename: Ian L
authors.initials: IL
authors.lastname: McAllister
mesh_terms: D000368:Aged; D000488:Allied Health Personnel / Q000193:education; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D016208:Databases, Factual; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011793:Queensland / Q000453:epidemiology; D012042:Registries; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards