First 5 years of Implementation of Diabetic Screening Program in Centro Hospitalar do Porto

Laureano

Neto

2020

Preprint

Background: The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes and difficulties. However, factors such as the existence of regional programmes, specificities of each country's health systems, organizational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Methods: Web of Science and PubMed platforms were searched using appropriate key words. Were found 423 articles, 28 of which were selected and analysed. Web sites of all Portuguese governmental and non-governmental organizations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed.Results: Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening.Conclusion: Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes.Registration PROSPERO registration ID CRD42020200115

Section: Discussionmentioning

confidence: 99%

Five Regions, Five Retinopathy Screening Programmes: A Systematic Review of the Portuguese Experience

Laureano

Neto

2020

Preprint

“…To truly understand these problems is important to know the hospitals point of view. Opportunely, one of the selected studies took place at the Hospital Center of Oporto (CHP), and provides the perspective of this hospital ophthalmology services [31]. The CHP is the reference hospital for 2 ARSN's ACES, which together represent about 293,900 inhabitants and 24,902 diabetics (data for 2016) [31].…”

Section: Discussionmentioning

confidence: 99%

“…The authors conclude that, the screening programme relevance and advantage to public health is evident. However, they highlight that at a time when involvement in the programme represents an increased effort for ophthalmology services, it is important to optimize all steps of the process [31].…”

Section: Discussionmentioning

confidence: 99%

Five Regions, Five Retinopathy Screening Programmes: A Systematic Review of how Portugal addresses the challenge.

RMdS

FBdL

2021

Preprint

Background: The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes and difficulties. However, factors such as the existence of regional programmes, specificities of each country's health systems, organizational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects.Methods: Web of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organizations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed.Results: Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening.Conclusion: Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics.Registration: PROSPERO registration ID CRD42020200115

“…Opportunely, one of the selected studies took place at the Hospital Center of Oporto (CHP), and provides the perspective of this hospital ophthalmology services [31]. The CHP is the reference hospital for 2 ARSN's ACES, which together represent about 293,900 inhabitants and 24,902 diabetics (data for 2016) [31]. An important nding that emerges from this research is that the screening programme is referencing to ophthalmologic consultation, patients who are already being followed in hospital services.…”

Section: Discussionmentioning

confidence: 99%

“…However, the overall screening strategy is rarely well described [16] and normally only the unilateral point of view of one type of stakeholder is explored, e.g. diabetics [29], health professionals [30], primary health care units [30], hospitals [31] and government [27]. As opposed to that, in this review we speci cally tried to identify alternative screening strategies and assess the challenges faced by the different levels of health care providers, producing a synthesis of the evidence available in the literature.…”

Section: Introductionmentioning

confidence: 99%

Five Regions, Five Retinopathy Screening Programmes: a Systematic Review of How Portugal Addresses the Challenge

Laureano

Neto

2021

Preprint

Background: The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes and difficulties. However, factors such as the existence of regional programmes, specificities of each country's health systems, organizational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Methods: Web of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organizations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed.Results: Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening.Conclusion: Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics.Registration: PROSPERO registration ID CRD42020200115.