Current Position Information
Family Practice Physician, Aurora Health Care
Scholarly Research Project
Eye See: Physician Reminders Increase Diabetic Retinopathy Screening Using a Digital Retinal Camera
Ahmed Ali Quraishi, MD; Barry Coutinho, MBBS
University of Pittsburgh Medical Center Shadyside Family Medicine Residency Program
Diabetic retinopathy (DR) is the most frequent cause of new cases of blindness among adults aged 20–74 years.1 The estimated prevalence of diabetic retinopathy is 28.5% among US adults with diabetes.2 Annual screening for DR followed by appropriate treatment can decrease rates of blindness.3 The goal of this project was to increase screening rates for DR at the Shadyside Family Health Center by increasing the use of an on-site digital retinal camera.
Several interventions were employed to improve screening rates, including physician education on the importance of DR screening, repeated verbal reminders to order the fundus photo for diabetic patients during the pre-clinic huddle, and weekly written email reminders. The Diabetes QI coordinator produced diabetic report cards, outlining patients' preventative care needs, to serve as patient and physician reminders. Photos were captured and sent to an ophthalmologist for interpretation. The number of patients who completed DR screening for a three-month period in 2018 before the interventions were compared to the same three-month period in 2019 after the interventions. QI approval was obtained prior to data collection.
Rates of DR screening using the digital retinal camera increased from 8% in 2018 to 17% in 2019, following the interventions (p<.05). 4 Among all clinic patients with DM, the rate of DR screening completion in 2018 was 46% and was 56% in 2019.
Repeated pre-clinic huddle reminders, weekly email reminders, diabetic report cards, and having a Diabetes QI coordinator were associated with the significantly increased use of point-of-care screening for DR. However, even with an onsite digital retinal camera, barriers to screening remain. These can include clinical staff turnover, technical issues with the fundus camera, and concerns about co-pays. One of the biggest barriers can be physicians failing to order the test.