title: Retinal photography for diabetic retinopathy screening in Indigenous primary health care: the Inala experience.
abstract: OBJECTIVE
  We aimed to determine the impact of clinic based retinal photography on access to appropriate screening for diabetic retinopathy (DR).
  
  
  METHODS
  We opportunistically recruited patients undergoing their annual diabetic cycle of care over a two year period in the urban Indigenous primary health care clinic. Data were collected on retinal outcomes, health variables and referral patterns.
  
  
  METHODS
  Access to appropriate screening and ophthalmic follow up, prevalence of DR, acceptability and feasibility of clinic-based retinal photography were the main outcome measures of this study.
  
  
  RESULTS
  One hundred and thirty-two of a possible 147 patients consented to participate. 30% of participants had DR. Appropriate screening and ophthalmic follow up increased six fold, from 20 to 124 participants, following the introduction of the retinal camera. Most participants felt very positive about DR screening.
  
  
  CONCLUSIONS
  Primary care DR screening using retinal photography can improve access to DR screening for indigenous patients, reduce the burden on busy outpatient departments and should reduce visual loss. Policy-makers could contribute to screening sustainability by funding a medicare item-number for primary care based DR screening associated with the annual diabetic cycle of care. An upfront Practice Incentive Program (PIP) payment could offset set up costs.
authors.affiliation: Discipline of General Practice, University of Queensland and Inala Indigenous Health Service, Royal Brisbane & Women's Hospital, Herston, Queensland. g.spurling@uq.edu.au
authors.forename: Geoffrey K P
authors.initials: GK
authors.lastname: Spurling
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Askew
authors.forename: Noel E
authors.initials: NE
authors.lastname: Hayman
authors.forename: Naomi
authors.initials: N
authors.lastname: Hansar
authors.forename: Anna M
authors.initials: AM
authors.lastname: Cooney
authors.forename: Claire L
authors.initials: CL
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D048909:Diabetes Complications / Q000208:ethnology; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010781:Photography; D015995:Prevalence; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014505:Urban Population; D055815:Young Adult