THE IMPLEMENTATION OF PROMPTED RETINAL SCREENING FOR DIABETIC EYE DISEASE BY ACCREDITED OPTOMETRISTS IN AN INNER-CITY DISTRICT OF NORTH LONDON - A QUALITY OF CARE STUDY

Diabetic retinopathy remains the most common cause of blindness in peo ple of working age but the provision of high quality eye screening for diabetic patients is still erratic in many health districts in the UK . National consensus guidelines recommend comprehensive population cov erage, high sensitivity (>80 %), high specificity (>95 %), agreed clin ical criteria, referral procedures and centralized data collection to facilitate audit. This study looks at the effectiveness of implementin g a prompted recall programme for retinal screening in an inner-city d istrict of North London. The scheme uses trained, accredited optometri sts to screen patients with diabetes who are looked after in the commu nity by their general practitioner. During the first 17 months of the scheme, 63 optometrists attended training and gained accreditation. Of the 666 patients recruited, 645 were scheduled for screening and 536 (83 %) attended. Fourteen per cent of patients screened were found to have background retinopathy and 2.3 % sight-threatening eye disease. I n two audits, carried out 15 months apart in a random sample of GP pra ctices, the incidence of recorded dilated fundoscopy increased from 48 % at baseline to 56 %, an increase of 8 % (95 % Cls 2 %-14 %). For re ferable eye disease, the sensitivity of this screening technique was 1 00 %, the specificity 94 % (95 % Cls 90 %-98 %), the positive predicti ve value 79 % (95 % Cls 72 %-86 %) and the negative predictive value 1 00 %. The administrative cost per case screened was pound 12.60 (exclu ding clinical costs and any additional optometry payment). (C) 1998 Jo hn Wiley & Sons, Ltd.