2. t IMPLEMENTATION OF A SCREENING PROGRAM FOR THE EARLY DETECTION OF DIABETIC RETINOPATHY USING A NON-MYDRIATIC CAMERA IN PRIMARY CARE Antoni Peris Carlos Bernades Emilia Bosch Sonia Burgos Susana Vilalta CASAP CAN BOU PISA – August 2010

3. Cognoms, Nom Primary care services: where are we heading? More efficiency and quality in public health services Higher resolution in primary care Higher autonomy for professionals More accesibility

4. Public consortia Local and autonmic governance (ICS – Ajuntament) Closeness to comunity Sinergies Legal independence Fast managing Public enterprise Finance accountability Public economic auditors Consorci Castelldefels Agents de Salut CASAP

5. DM2 prevalence is 2-6% Diabetic Retinopathy (DR) is the 1st cause of blindness in Western populations (70-80% of blindness for patients from 20 to 70) Early diagnosis of DR can stop its development. Diabetic Retinopathy

6. Fundi in DM2 The guidelines recommend control of Fundi when Diagnosis and thereafter, annual control The coverage in Catalonia is 50% of the population for the service of Ophthalmology, and the controls are every 3-4 years.

7. Fundi in DM2: CROC Use of non-mydriatic Ophtalmoscopy camera covers 70-100% of needed explorations. This facilitates increasing early detection and proper treatment reducing cases of blindness

8. What is CROC? Unit dedicated to eye screening of patients with DM2 : Non-mydriatic Ophtalmoscopy camera Air Tonometer (rule out high IOP) Visual acuity

9. What we look for in CROC? The papilla Microaneurysms Hemorrhage Exudates (hard and soft ) Neovascularization Others

10. CROC STRATEGIES Training Professional: – 2 Family doctors in each PC Team – It consists of : 2 hours Theory session 20 hours practical Fundi reading with ophtftalmologist – Nurse aid training in other CROC team for 1 month

11. CROC PATHWAYS – GP or Nurse programs CROC visit – Nurse aid performs CROC – CROC GP avaluate pictures. – Ophtalmologists avaluates situation when in doubt – According to the result patient is followed in CROC or referred to Ophtalmology to avoid delays

12. Ophtalmologist’ referrals Miosi Cataracts High OIP Moderates NPDR Severes NPDR PDR Photocoagulation

13. Total Visits CROC Castelldefels: 1481 RESOLUTION CROC 2008

14. Ophtalmologist’ referrals CROC avoids appointments of 1037 patients/year from Castelldefels to Ophtalmologist Referred patients (30% of total CROC patients) have been properly diagnosed by GP

15. CROC DIAGNOSTICS 1.Nonproliferative Diabetic Retinopathy (NPDR) 1.Mild 2.Moderade 3.Severe 2.High IOP 3.Cataract Total: 368

16. Discussion Pro’s: – Ophtalmologist waiting lists are reduced – Ophtalmologists visits only disease cases – Primary care shows higher autonomy and resolution capacity. – When severe disease, pacient meets Ophtalmologist before 48 hours.

17. Discussion Against: – Slight lack of coordination on Ophtalmologists reading results (delay on avaluation both of doubts and disease) – Purchaser is not currently paying PC Teams for CROC activity while it goes on paying hospital as always

18. Discusion Population screening of diabetic retinopathy using CROC has been effective in considerably increasing photos taken and in new diagnosis of retinopathy, with respect to previous years. The program avoided 1037 visits to the ophthalmology service en one year. The 400 patients that were referred already had a diagnostic orientation.

19. t cbernades @casap.cat ¡Muchas gracias! Moltes gràcies! Thank you very much! Merci Beaucoup! Muito Obrigado! Grazie Mille! Mulţumesc Foarte Mult! Ezkerrik Azko!