A national survey of the current state of screening services for diabetic retinopathy: ABCD-diabetes UK survey of specialist diabetes services 2006.
The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen-positive cases. Eighty-five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty-five per cent of screening units use 'call and recall' for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen-positive patients was a cause for concern. The fast-track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty-six per cent of the programmes reported inadequate resources to sustain a high-quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA.
Nagi
D K
DK
Diabetes and Endocrinology, Pinderfields General Hospital, Wakefield, UK. dinesh.nagi@midyorks.nhs.uk
Gosden
C
C
Walton
C
C
Winocour
P H
PH
Turner
B
B
Williams
R
R
James
J
J
Holt
R I G
RI
D003920:Diabetes Mellitus; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration / Q000592:standards*; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D006113:United Kingdom