title: [Implementation of diabetic retinopathy screening using digital retinography in primary care].
abstract: OBJECTIVE
  To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC).
  
  
  METHODS
  Prospective longitudinal descriptive study.
  
  
  METHODS
  Area 11 Primary Care, Madrid.
  
  
  METHODS
  Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO).
  
  
  METHODS
  Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist.
  
  
  METHODS
  Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c).
  
  
  METHODS
  September 2009-September 2011.
  
  
  RESULTS
  DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001). The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<.001), respectively.
  
  
  CONCLUSIONS
  NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images.
authors.affiliation: Equipo Directivo, Gerencia de Atención Primaria, Área 11 de Madrid, Madrid, España. lcrodriguez.gapm11@salud.madrid.org
authors.forename: Lidia Clara
authors.initials: LC
authors.lastname: Rodríguez García
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gómez de Cádiz Villarreal
authors.forename: Javier
authors.initials: J
authors.lastname: Pérez Rivas
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Muñoz González
authors.forename: Gabriela
authors.initials: G
authors.lastname: García Álvarez
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Alonso Salazar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D055815:Young Adult