A national survey of the current state of screening services for diabetic retinopathy: ABCD–Diabetes UK survey of specialist diabetes services 2006

Abstract

The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen-positive cases. Eighty-five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty-five per cent of screening units use 'call and recall' for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen-positive patients was a cause for concern. The fast-track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty-six per cent of the programmes reported inadequate resources to sustain a high-quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA.

Diabetic retinopathy screening in New Zealand requires improvement: results from a multi‐centre audit

“…Given the lack of national standards, training and accreditation for graders in NZ, this is not surprising, and is in contrast to England where 84% of primary graders are trained retinal screener graders. 15 Our findings support intentions "to define and develop suitable national accreditation and qualifications for primary and secondary graders as part of the ongoing quality assurance work" 9 and to implement intergrader quality assurance initiatives to assess the quality and accuracy of primary grading. 10,16 Intergrader consistency is considered a critical feature of effective retinal screening, 10,17 and relative grading experience does contribute to differences in grading.…”

“…Limited clinical capacity was identified as a significant factor contributing to an inability of services to meet targets in a recent survey of the current state of retinal screening services in the England. 15 About half of retinal screening programs reported waiting lists for screen positive patients who needed further assessment and/or treatment for retinopathy. Moreover about two-thirds of programs reported having inadequate resources to provide a high quality service.…”

A decade in diabetes specialist services, 2000 to 2011, in England: the views of consultant diabetologists and diabetes specialist nurses amidst persistent healthcare delivery change

“…A qualitative longitudinal case study approach was taken to meet the exploratory nature of the research using data from open-text national survey responses in 2000 and 2006 [1][2][3][4][5][6][7] and transcript data from semi-structured interviews in 2011.…”

The Evidence for Automated Grading in Diabetic Retinopathy Screening

“…Quality assurance: Another possible role for automated grading is quality assurance since this is a significant component of the work involved in the maintenance of a screening programme [35]. Internal quality assurance requires checking samples of grading results which are large enough to detect suboptimal performance by graders.…”