Diabetic retinopathy: effects of national guidelines on the referral, examination and treatment practices of ophthalmologists and optometrists

Objective: To investigate the changes in referral. examination and treatmen t practices for diabetic retinopathy by ophthalmologists and optometrists f ollowing the release of national guidelines. Methods: A two-page self-administered questionnaire was mailed to all Austr alian ophthalmologists and a random sample of 500 Australian optometrists p rior to and 1 year after release of the National Health and Medical Researc h Council of Australia (NHMRC) clinical practice guidelines for the managem ent of diabetic retinopathy. The questionnaires elicited information about current practice related to the management of patients with diabetic retino pathy. Results: Of the 464 contactable ophthalmologists who responded to the basel ine survey. 374 (80.6% response) completed the follow-up survey. The respon se rate for the contactable optometrists was 80.1% (310 of 384). There were almost no significant changes in management practices from baseline to fol low up. For example. the percentage of ophthalmologists who reported that t hey were often or almost always confident in detecting moderate retinal thi ckening near the macula remained nearly identical from baseline to follow u p (80.2% vs 79.1%). The rate was also similar from baseline to follow up fo r optometrists (31.1% vs 28.8%), The one area in which ophthalmologists rep orted significant changes in management towards agreement with the NHMRC gu idelines was use of angiography; they were less likely to manage their pati ents this way (20.4% vs 14.2% With laser and 48.9% vs 38.4% without laser f or increasing level of severity in clinical signs; both P < 0.05). Conclusions: The NHMRC guidelines for diabetic retinopathy have been succes sfully distributed to ophthalmologists and optometrists in Australia. Howev er; the mere provision of the guidelines has had little impact on managemen t practices. It will be important to determine if ongoing dissemination and implementation strategies not only increase awareness of health-care pract itioners to the guidelines, but also change behaviours.