title: Digital retinal imaging in a residency-based patient-centered medical home.
abstract: OBJECTIVE
  Diabetic retinopathy is the leading cause of blindness in adults in the United States, and early screening/treatment may preserve vision. This study examined the feasibility of using non-mydriatic digital retinal imaging (DRI) for retinopathy screening in a busy family medicine residency program at the point of care using a nurse-driven protocol.
  
  
  METHODS
  We compared the number of diabetics screened during a 1-year period before and after DRI protocol implementation. We also determined the prevalence of retinopathy, assessed patient satisfaction with the alternative screening process, and tracked ophthalmologic appointment compliance for patients referred because of abnormal screening results.
  
  
  RESULTS
  Screening approximately doubled from 161 patients/year before the protocol to 330 patients/year after protocol implementation. However, DRI screening had no impact on ophthalmologic appointment compliance; only 58% of 153 patients referred for ophthalmologic evaluation because of positive screening findings completed their referral appointment. Seven cases needing urgent ophthalmologic treatment were identified. Satisfaction with primary care retinopathy screening was high.
  
  
  CONCLUSIONS
  Use of a nurse-driven protocol for digital retinal imaging at the point of care dramatically improves rates of annual retinopathy screening in academic family medicine practice and can identify patients who require subspecialty referral. However, DRI screening does not improve visit compliance rates with ophthalmologists for evaluation and management.
authors.affiliation: Department of Family Medicine, Brody School of Medicine, East Carolina University, NC 27834, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Newman
authors.forename: Doyle M
authors.initials: DM
authors.lastname: Cummings
authors.forename: Lisa
authors.initials: L
authors.lastname: Doherty
authors.forename: Nick R
authors.initials: NR
authors.lastname: Patel
mesh_terms: D000328:Adult; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005194:Family Practice / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D014481:United States