Aboriginal Health Workers the Key To Better Eye Screening Rates
Screening rates for eye complications of type 2 diabetes dramatically increased in remote Aboriginal communities with the introduction 10 years ago of a novel program using retinal cameras operated by Aboriginal health workers and nurses.
In an article in the latest issue of the Medical Journal of Australia, Dr Richard Murray, Medical Director of the Kimberley Aboriginal Medical Services Council, Broome, WA, and colleagues at the Council, the Kimberley Population Health Unit, Broome, and the Lion's Eye Institute, Perth, evaluate the program designed to promote retinal screening in Aboriginal communities .
Despite the fact that type 2 diabetes affects up to 25 per cent of Aboriginal adults, access to primary health care is poor, and expenditures are inequitable. Before 1995, retinal screening in the Kimberley region was performed only periodically at hospital clinics by visiting ophthalmologists who travelled 2000-3000kms from Perth. The estimated screening rate was 10 per cent and many patients had end-stage diabetic retinopathy by the time they were tested. As a result, calls were made to provide a more accessible and less conventional approach to retinal screening.
The response was to train and assist local workers in the use of non-mydriatic fundus cameras. This has significantly freed specialist consulting and procedural time.
Since October 1999, 37 camera operators (including 11 Aboriginal health workers and 20 registered nurses) recorded 2587 episodes of retinal screening. Of the Aboriginal clients with diabetes registered on local databases, 48 per cent had a retinal screening within the previous 18 months, and 65 per cent within the previous 30 months.
Of the Aboriginal clients screened, 21% had signs of diabetes-related eye damage and 3.5% were found to have sight-threatening lesions. By finding these eye complications early, clients were able to access laser treatment to prevent blindness.
Dr Murray found that the quality of retinal photographs was not related to the operator's qualifications, certification or experience, and as such formal certification appears to be unnecessary. The authors also attribute the increase in timely retinal screening to policies that make primary health care providers responsible for care coordination.
"This study shows that a devolved program of screening for retinal complications of diabetes in a remote Aboriginal population can be successfully performed by Aboriginal health workers and nurses using non-mydriatic fundus cameras and sustained over a period of time with regional support," Dr Murray said.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Dr Richard MURRAY 0417008791 and 0891936043 (to COB Fri 13thMay)
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471