title: Quality-assured screening for diabetic retinopathy delivered in primary care in Ireland: an observational study.
abstract: BACKGROUND
  At present, there is no national population-based retinopathy screening programme for people in Ireland who have diabetes, such as those operating in the UK for over a decade.
  
  
  OBJECTIVE
  To evaluate a community-based initiative that utilised existing resources in general practice and community optometry/ophthalmology services to provide screening for diabetic retinopathy.
  
  
  METHODS
  Cross-sectional study using electronic ophthalmic patient screening records in community optometry clinics in Cork, Ireland.
  
  
  METHODS
  A purposive sample of 32 practices was recruited from Diabetes in General Practice, a general practice-led initiative in the South of Ireland. Practices invited all adult patients registered with diabetes to participate in free retinopathy screening (n = 3598), provided by 15 community optometry practices and two community ophthalmologists. Data were recorded on an electronic database used by optometrists and the performance was benchmarked against proposed national standards for retinopathy screening.
  
  
  RESULTS
  In total, 30 practices participated (94%). After 6 months, 49% of patients (n = 1763) had been screened, following one invitation letter and no reminder. Forty-three per cent of those invited consented to their data being used in the study and subsequent analyses are based on that sample (n = 1542). The mean age of the patients screened was 65 years (standard deviation = 13.0 years), 57% were male (n = 884), and 86% had type 2 diabetes (n = 1320). In total, 26% had some level of retinopathy detected (n = 395); 21% had background retinopathy (n = 331), 3% had pre-proliferative retinopathy (n = 53), and 0.7% had proliferative retinopathy (n = 11).
  
  
  CONCLUSIONS
  The detection of retinopathy among 26% of those screened highlights the need for a national retinopathy screening programme in Ireland. Significant learning, derived from the implementation of this initiative, will inform the national programme.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland. s.mchugh@ucc.ie
authors.forename: Sheena
authors.initials: S
authors.lastname: McHugh
authors.forename: Claire
authors.initials: C
authors.lastname: Buckley
authors.forename: Katie
authors.initials: K
authors.lastname: Murphy
authors.forename: Sue
authors.initials: S
authors.lastname: Doherty
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Keeffe
authors.forename: Joseph
authors.initials: J
authors.lastname: Alade
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Keane
authors.forename: Mark
authors.initials: M
authors.lastname: James
authors.forename: Ciaran
authors.initials: C
authors.lastname: Coughlan
authors.forename: John
authors.initials: J
authors.lastname: Traynor
authors.forename: Colin P
authors.initials: CP
authors.lastname: Bradley
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
authors.forename: Joe
authors.initials: J
authors.lastname: Moran
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Quinlan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000592:standards; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000628:therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D058006:General Practice / Q000592:standards; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000592:standards; D009907:Optometry / Q000592:standards; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult
references.citation: Eye (Lond). 2010 Nov;24(11):1692-9
references.pmid: 20847749
references.citation: Diabetologia. 2002 Jul;45(7):S5-12
references.pmid: 12136405
references.citation: Diabetes Care. 2003 Jun;26(6):1731-7
references.pmid: 12766102
references.citation: Health Technol Assess. 2000;4(14):i-vii, 1-133
references.pmid: 10984843
references.citation: Diabetes Care. 1999 May;22(5):752-5
references.pmid: 10332676
references.citation: Diabet Med. 2002 Dec;19(12):1014-21
references.pmid: 12647843
references.citation: Diabetologia. 1995 Apr;38(4):437-44
references.pmid: 7796984
references.citation: BMJ. 2010 Oct 25;341:c5400
references.pmid: 20974661
references.citation: Ophthalmic Epidemiol. 2007 Nov-Dec;14(6):375-80
references.pmid: 18161611
references.citation: Br J Ophthalmol. 2006 Mar;90(3):367-71
references.pmid: 16488964
references.citation: Prim Care Diabetes. 2009 Nov;3(4):225-31
references.pmid: 19837640
references.citation: Diabet Med. 2002 Jul;19 Suppl 4:44-9
references.pmid: 12121337
references.citation: Diabetologia. 2002 Jul;45(7):S13-7
references.pmid: 12136406
references.citation: JAMA. 2003 Oct 15;290(15):2057-60
references.pmid: 14559961
references.citation: Br J Ophthalmol. 1983 Apr;67(4):209-13
references.pmid: 6830738
references.citation: Ir J Med Sci. 2008 Dec;177(4):303-8
references.pmid: 18641918