Diabetic retinopathy (DR) is a public health issue, potentially impacting the lives of 3 million or more Canadians (7.9% of the population). If DR is detected early, vision loss can be averted. It is currently impossible to systematically identify individuals living with diabetes who have not had an annual eye examination using only primary care electronic medical records. A different approach is required.
A provincial-level identification or a “top-down approach” to identify individuals requiring screening for DR is being evaluated. Given the complexity of the problem, we are using a convergent mixed-methods implementation-effectiveness hybrid evaluation approach to evaluate the provision of a DR-unscreened list to a community-based health-care setting, in terms of effectiveness, cost-effectiveness, implementation and policy barriers and key success factors.
The intervention of providing a DR-unscreened list is initially being tested at three community health centres (CHCs) in Toronto. The number of individuals being contacted ranges from an estimated 575 to 900 at each CHC. Semi-structured interviews regarding eye care are being conducted with individuals that were contacted by the CHCs, independent of whether or not they choose to use the Tele-Retina services.
This top-down approach to provide primary care settings with DR screening status of their patients can raise awareness and DR screening accessibility, especially for vulnerable populations. Further implementation and evaluation of this strategy across Canada could lead the way to the development of a national DR screening registry, increased screening rates, and reduced vision loss.