Dr Deborah Askew Project: Discipline of General Practice, The University of Queensland Funding: Supported by the Primary Health Care Research, Evaluation and Development Strategy

Diabetic retinopathy (DR) is the leading cause of preventable blindness in adults in Australia, but if detected and treated early almost all severe vision loss and blindness can be prevented.

Despite the significant benefits, more than one in five Australians with diabetes do not access appropriate DR screening, which is currently provided by optometrists and ophthalmologists, on referral from GPs.

GPs provide most of the medical care to people with diabetes, but a lack of training and equipment limits their ability to screen for DR.

This study tested general practice based DR screening with two GPs, one from an indigenous health service and one from a general practice diabetes clinic. After training they reported on patient retinal photographs taken by a practice nurse with a non-mydriatic camera (used to photograph the retina without dilating the pupils). Comparison to ophthalmologist assessments of the photographs found the GPs’ diagnostic sensitivity and specificity met the national DR screening criteria.

Access to culturally competent health services is an issue for indigenous Australians. This project enabled an Indigenous Health Service to provide DR screening to their patients with diabetes within a physical setting where the patients were comfortable and safe, by health care professionals they knew and trusted. They found that 58% of their patients with diabetes (49/84) did not have DR, and therefore no longer required referral to the ophthalmology outpatient department 20 kms away. This demonstrates the potential of this project to reduce the number of inappropriate referrals to ophthalmologists.

This research successfully tested an innovative model of primary care that demonstrates GPs can  use advanced skills in routine practice and positively affect access to services and health outcomes.