Patient Recalls Patient recalls
can be categorized into two types:
• Routine: patients who have not previously had evident diabetic
retinopathy are recalled routinely every two years for photoscreening.
• Non-routine: patients who have previously been found to have
retinopathy are recalled along strict timeframes dictated by robust
management guidelines.
Recalls for photoscreening are generally managed via the patient’s
GP. This is appropriate as this is likely the point of most frequent
contact with the patient, and the GP oversees the patient’s general
medical management and so has access to current general health and disease
control indicators.
It is important to recognise that recall systems are generally run by
software based practice management systems, which may default to one
or two year recall timeframes. This fits well with the guidelines for
routine photoscreening reviews; but in cases where more frequent photoscreening
is indicated, unstable control or high risk retinopathy for example;
this should be clearly and prominently indicated on the report. Clear
indication of why the individual case needs to be more closely monitored
is also important.
Appropriate management of system recall comes with a “duty of
care” obligation and all communication should endevour to make
this as easy to manage as is possible.
Ophthalmology Referral
Primary Referral Pathway:
Community based diabetic retinal photoscreening programs allow hospital
ophthalmology clinics to spend their time more productively by screening
and treating only active retinopathy. Accurate scheduling of referrals
to ophthalmology is therefore critical to the efficient function of
this model. Communication between ophthalmology care and optometric
photoscreening needs, therefore to communicate the stage/grading of
retinal disease and the urgency of the referral accurately.
Information that should be included:
• Patient Details and NHI Number
• Appropriate medical detail and details of General Practitioner
• Visual Acuity – Habitual and Pinhole
• Retinal photoscreening grading
• Referral urgency – this may be implicit in the grading
guidelines, but it is likely that some cases may require urgent and
semi-urgent attention the this needs to be clearly communicated. (eg.
Neovascular disease or macular thickening)
• Other relevant information
Secondary
Referral Pathway:
Co-morbid pathologies are likely to be detected as a “by catch”
of photoscreening programs; referral mechanisms to appropriate care
should therefore be part of this communication pathway. It is probably
not appropriate that these patients be referred into hospital diabetic
clinics and so an alternative referral pathway should be established
for these patients.
Information that should be included:
• Patient Details and NHI#
• Appropriate medical detail and details of General Practitioner
• Visual Acuity – Habitual and Pinhole
• Retinal photoscreening grading
• REASON FOR REFERRAL
• Referral urgency – this would not be indicated by the
photoscreening grading and should be clearly stated on the referral
Conclusion:
Effective inter-professional communication underpins all photoscreening
programs and this needs to be robust and accurate enough to ensure that
correct information is available at the appropriate point in the communication
chain. This chain should include general medical practice, optometry,
public ophthalmology and the patient themselves. Inter-professional
communication should facilitate diabetic retinopathy photoscreening
delivery and not obstruct it. Medical accuracy and patient privacy are
core concepts of this and all communication pathways should facilitate
prompt, case specific, treatment as delays in this communication pathway
may seriously compromise patient care.
It is appropriate that individual programs evolve their own systems,
which are practically and culturally relevant to both service providers
and patients. These should ideally include variations in method, format
and language, but the outcomes should be the efficient delivery of a
service that prevents blindness in the diabetic patient.