title: [Diabetic retinopathy screening programme in primary health care. Diagnostic concordance between family and eye care practitioners].
abstract: OBJECTIVE
  To evaluate the diagnostic concordance in retinography interpretation between primary care and eye care practitioners and assess the soundness index of a diabetic retinography screening programme during its implementation stage.
  
  
  METHODS
  Descriptive, observational study was conducted on a sample of 243 patients with diabetes mellitus (type 1 and 2) over age 14, in 2 urban health care centers, gathered in an opportunistic manner between the dates of 21/07/2011 and 26/01/2012. A 45° digital bilateral retinography, intraocular pressure and visual acuity were obtained from each patient. The primary care practitioners prepared a report for each patient, which was telematically sent to the eye care doctor within the corresponding retinographies. A new diagnostic report was prepared then by the eye care doctor after revising the images. The lack of retinographies and/or reports were considered both as losses. The diagnostic concordance between the observers and the validity and reliability from the screening programme were estimated.
  
  
  RESULTS
  The kappa value obtained was 0.62 (95% CI 0.42-0.82) and 0.89 PABAK. The following validity indexes were obtained: Sensitivity 68.8%, specificity 96.5%, positive and negative predictive values: 61.1 and 97.5%, respectively. A percentage of 57.2 of the patients were not observed any pathology requiring referral to a eye care doctor.
  
  
  CONCLUSIONS
  The concordance value obtained varied between considerable and almost perfect, depending on the index used for the analysis (kappa/PABAK, respectively). It's worth highlighting that carrying out retinographies in the primary care centers enhances patient-treatment capacity of the primary care doctors and the patients accessibility to screening.
authors.affiliation: Centro de Salud Calzada II, Gijón, Asturias, España.
authors.forename: C
authors.initials: C
authors.lastname: Alonso Porcel
authors.affiliation: Centro de Salud Calzada II, Gijón, Asturias, España. Electronic address: martamartineziban@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Martínez Ibán
authors.affiliation: Centro de Salud El Coto, Gijón, Asturias, España.
authors.forename: L
authors.initials: L
authors.lastname: Arboleya Álvarez
authors.affiliation: Unidad de Investigación Área V, Gijón, Asturias, España.
authors.forename: P
authors.initials: P
authors.lastname: Suárez Gil
authors.affiliation: Centro de Salud Contrueces, Gijón, Asturias, España.
authors.forename: L M
authors.initials: LM
authors.lastname: Sánchez Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D005194:Family Practice / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D015588:Observer Variation; D009885:Ophthalmology / Q000379:methods / Q000592:standards; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Concordancia interobservador; Diabetes mellitus; Diabetic retinopathy; Digital retinography; Fiabilidad y validez; Interobserver agreement; Reliability and validity; Retinografía digital; Retinopatía diabética