INTEGRATED SCREENING Margaret Bruce Sarah Anderson INTEGRATED SCREENING
INTEGRATED SCREENING Margaret Bruce & Sarah Anderson
INTEGRATED SCREENING The purpose of today’s workshop is to outline how we carry out both diabetic retinal screening and the now integrated diabetic foot screening.
Facts & Figures n n In Type 2 diabetes more that 30% of patients have visible retinopathy at diagnosis. 22. 4% of the diabetic population in Grampian have been recorded with some retinopathy present in one or both of their eye’s.
Diabetic Retinal Screening The purpose of screening for diabetic retinopathy is to reduce the level of blindness within the diabetic population. As diabetic retinopathy is one of the largest causes of blindness in the working population.
Risk Factors For Diabetic Retinopathy n n n Duration of Diabetes Poor Glycaemic control Raised Blood Pressure Increasing Number of Microaneurysms Pregnancy
Retinal Screening We carry out a visual acuity test to check the patients vision. § § We then determine if the patient requires dilation of the pupils, if so, drops are administered and should take effect in around 15 minutes.
Retinal Screening n n n We then position the patient on the camera, for this the patient requires to have reasonably good upper body mobility, Images are then captured, Patient is then informed that a letter with their results should be with them within 4 weeks and their GP can access these results also.
Ability to lean forward and maintain contact with chin and head rest required.
Grading for Retinopathy Grading identifies the features of retinopathy and stratifies the risk of developing sight threatening retinopathy
Retinal Screening In order for the images taken to be graded they have to be of sufficient quality and clarity. If the grader has made the decision that the images is of poor quality the patient will be recalled to attend a Slit Lamp clinic.
Field Position The entire optic disc should be visible with a thin rim of retina The fovea is at least 2 dd from the edge of the retina
Grading scheme 2007
Technical Failure Images Both Images taken with dilation after a period of 20 minutes
CATARACT
Slit Lamp Technical Failure Clinic n n n CATARACT PATIENT FACTOR SMALL PUPILS DROOPING EYE LIDS PATHOLOGY
Results n n n R 0= No diabetic retinopathy 12 months R 1= Mild retinopathy 12 months R 2= Observable retinopathy 6 months R 3= Referable retinopathy Ophthalmology R 4= Proliferative retinopathy Ophthalmology R 6= Not adequately visible Tech. Failure Scottish Diabetic Retinopathy Grading Scheme 2007 v 1. 1
26 year old female
Annual Foot Screening – WHY? n n n The purpose of diabetic foot screening is to detect patients that are showing signs of neuropathy and /or ischemia. Such patients are at risk of developing foot ulcers. We can minimise the risk by annual screening, providing education and foot care advice.
Foot Screening A 10 mg monofilament is used for detecting any possible impairment in the patients sensation.
Foot Screening Posterior Tibial pulse Absent pulses may indicate ischaemia which should be further investigated by podiatry Dorsalis Pedis
Foot Screening As part of the screening we also ask patients if they have any other podiatry concerns with their feet. For example corns, nail problems, callus. If they do complain of such we will check if they are currently attending podiatry services.
Foot Screening As part of the foot screening integration with retinal screening we have been asked to get feedback from our patients as regards on how they feel about the integrated service. The combination of eye and foot screening appointment saves the patient valuable time.
Foot Screening Following are some figures taken from our feedback forms we have asked our patients to complete since we started the integrated service. Feedback has been extremely positive.
Foot Screening Do you like combined one stop screening?
Foot Screening Do you know what HBA 1 c means?
Foot Screening Do you know what foot screening means?
Foot Screening Have you had your feet checked within the last 2 years?
Foot Risk Stratification for Grampian 2008 (Diabetes Survey) n n 101 recorded with Active foot disease. 20 recorded with High foot Risk 56 recorded with Medium foot risk 601 recorded with Low foot risk
Foot Screening Diabetes Survey 2008 Lower Limb Amputations 1051 people are recorded as having a lower limb amputation (0. 5%)
Foot Screening Foot Complications 16, 217 people in Grampian had their feet checked (including peripheral pulses) in the last 15 months. (Total Patients 21, 282) 443 known patients are recorded as having a foot ulcer (2. 1%) Diabetic Survey 2008
Figures to date Total of patients screened = 1579 High risk referral = 30 Moderate risk referral = 14 Low risk referral = 104 Start date of screening 04/03/2009
Questions from the floor?
- Slides: 35