title: Further survey of Australian ophthalmologist's diabetic retinopathy management: did practice adhere to National Health and Medical Research Council guidelines?
abstract: BACKGROUND
  To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines.
  
  
  METHODS
  Self-reported cross-sectional survey of patterns of practice. Questionnaires were sent to all Australian ophthalmologists, comprising questions regarding professional details, diabetic retinopathy screening attitudes/practices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression.
  
  
  RESULTS
  480 of the 751 (64%) eligible Australian ophthalmologists participated. The majority (80%, n = 376) reported they consistently reviewed patient's glycaemic control, but only 55% and 41% regularly reviewed blood pressure and serum cholesterol control, respectively. Ophthalmologists generally adhered to NHMRC-recommended screening intervals, although only 38% agreed with the guidelines relating to screening of pre-pubertal diabetic patients. Fluorescein angiogram was used more than recommended, especially for mild non-proliferative diabetic retinopathy where 45% of respondents used this investigation. Practice duration >15 years was associated with more regular fluorescein angiogram use (OR = 3.74; 95% CI: 2.53-5.53, P < 0.001). In the clinical scenarios where clinically significant macular oedema was concurrently present with cataract or proliferative diabetic retinopathy, >26% referred to retinal subspecialists for management; 85% of the remaining ophthalmologists performed macular laser first. Respondents with practice duration >15 years were 7.8 times (P = 0.001) more likely to perform cataract surgery first.
  
  
  CONCLUSIONS
  Diabetic retinopathy management guidelines were generally well followed by Australian ophthalmologists. However, areas of practice variation existed including frequent use of fluorescein angiogram. Significant proportion of practitioners referred diabetic patients to retinal subspecialists, who were more likely to adhere to guideline recommendations. Ophthalmologists with greater experience (>15 years) were more likely to employ practices differing from NHMRC recommendations.
authors.affiliation: Eye and Vision Epidemiology Research Group, Centre for Health Services Research, School of Population Health, The University of Western Australia, Crawley, West Australia, Australia. shunnus@hotmail.com
authors.forename: Joshua
authors.initials: J
authors.lastname: Yuen
authors.forename: Antony
authors.initials: A
authors.lastname: Clark
authors.forename: Jonathon Q
authors.initials: JQ
authors.lastname: Ng
authors.forename: Nigel
authors.initials: N
authors.lastname: Morlet
authors.forename: Jill
authors.initials: J
authors.lastname: Keeffe
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Taylor
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
mesh_terms: D001315:Australia; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000628:therapy*; D005451:Fluorescein Angiography; D019983:Guideline Adherence; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000592:standards*; D009885:Ophthalmology / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D002784:Cholesterol