title: [Coverage and results of a screening program for diabetic retinopathy using mydriatic retinography in primary health care].
abstract: OBJECTIVE
  To identify the coverage of a diabetic retinopathy screening program in primary health care and to assess agreement between ophthalmologists and family physicians (FP) regarding retinography evaluations of diabetic patients.
  
  
  METHODS
  Cross-sectional observational study,with a review of diabetic patients' mydriatic retinographies (2007-2008) from three urban primary health centers (PHC)(Jaén-Spain).
  
  
  RESULTS
  A total of 296 retinographies in 2007 and 380 in 2008 (coverage=26% ± 2,4) were reviewed. Pathological retinographies were identified by 181 FPs (27% ± 1,3) and 59 (9% ± 0,3) ophthalmologists.Total agreement was moderate (kappa=0, 408 ± 0,039).Agreement was better in the latter year (0,45 vs 0,34; p < 0,001 test χ²). FP evaluations showed 97% sensitivity, 80% specificity, 33% positive predictive value, 100% negative predictive value, 4, 88 positive likelihood ratio and 0,04 negative likelihood ratio. We find variability in coverage and agreement between PHC.
  
  
  CONCLUSIONS
  Mydriatic retinographies performed and evaluated by FPs are useful to retinopathy screening of diabetic patients. Coverage, predictive values and likelihood ratio were better in the latter year, although the interpretation should be homogenized.
authors.affiliation: Centro de Salud de Valdepeñas (Jaén), Servicio Andaluz de Salud, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vargas-Sánchez
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Maldonado-Valenzuela
authors.forename: Francisco Tomás
authors.initials: FT
authors.lastname: Pérez-Durillo
authors.forename: José
authors.initials: J
authors.lastname: González-Calvo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pérez-Milena
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D003930:Diabetic Retinopathy / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009184:Mydriatics; D015588:Observer Variation; D009885:Ophthalmology; D010781:Photography / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D017216:Telemedicine
chemical_list: D006442:Glycated Hemoglobin; D009184:Mydriatics