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Gilli C. Vafidis, Jack Bernhardt, Evelyn Mensah; Tracking Patients With Referable Diabetic Retinopathy In Cross Boundary Hospital Clinics. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1286.
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Reducing blindness from diabetic retinopathy requires screening and treatment of those at risk. The English National Screening Programme for Diabetic Retinopathy (ENSPDR) aims to monitor all diabetic people over 12 years’ age. In each regional programme, grading of digital retinal photographs determines whether subjects are returned to annual recall or referred to same region hospital DR clinics for treatment. Exceptions are those with referable retinopathy who tell screeners they currently attend cross boundary (CB) hospitals for retinopathy. Our CB protocol requires retinopathy status to be verified by family doctor or CB hospital. This audit looked at CB patients 3 - 33 months after 1st screening to determine their retinopathy and pathway status
Pathway, retinopathy and demographic status of 200 patients in Brent CB were determined from correspondence received 3/2008-9/2010 and from screening, same region hospital and national databases
Since 2008 Brent DR Screening Programme (18846 registered patients) referred 3374 patients to the same region hospital for treatment (17.9%). In addition, 200 CB referable retinopathy patients claimed to be in care at 1 of 10 cross boundary hospitals. Only 49% (99 patients) had CB pathway confirmation. A further 35% (70) were accounted for by i) 33 returned to screening, ii) 21 in same region hospital DR clinic, iii)10 moved away and iv) 6 died. But 31 CB patients (15%) had no verified pathway data for up to 2 years
Our audit showed that it is unsafe to assume that CB patients are in a pathway. Until inter-hospital communication is reliable, we recommend referral back to the regional DR screening programme within 12 months of first screen if pathway status cannot be verified.
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