Enhancing integrated care for community-based diabetic retinopathy screening supported by provincial administrative data

Background: Diabetic retinopathy (DR) remains a significant public health concern, with over 30% of Canadians living with diabetes unscreened according to clinical guidelines. Identifying individuals in need of diabetic retinopathy screening (DRS) at the community practice level is challenging, often relying on patient self-report. While DRS status is captured in provincial administrative datasets, this information is not readily accessible to community-based providers.

 

Approach: This study evaluated the use of Tele-Retina DRS at three Community Health Centres (CHCs) in Ontario, leveraging provincial administrative data to identify unscreened individuals. Community partners were engaged throughout the design, implementation, and monitoring phases. Individuals with diabetes who had not undergone retinopathy screening in the previous 425 days were identified via healthcare administrative datasets and abstracts of CHC electronic medical records.

 

Data were securely transferred to CHCs, which conducted telephone outreach using a two-stage consent process, with first obtaining an individual's permission to use the received information, and a second stage to participate in the evaluation. Eligible individuals were offered Tele-Retina screening at CHCs or referred to optometrists/ophthalmologists. All Tele-Retina images were reviewed by ophthalmologists, with treatment recommendations provided as needed.

 

The intervention was assessed for interest, uptake, and retinopathy status, as part of a convergent mixed-methods implementation-effectiveness hybrid evaluation to evaluate the provision of a DR unscreened list to a community-based healthcare setting in terms of effectiveness, cost-effectiveness, implementation, integration and policy barriers and key success factors. The study was approved by the University Health Network Research Ethics Board (20-5249).

Results: Data transfer was completed for two CHCs. Between February 2022 and June 2023, 5649 calls were made to 4304 individuals. Contact was established with 1641 (38.1%), and 438 (26.7%) consented to data access. Of those consenting, 95% expressed interest in Tele-Retina, with 377 (90.6%) scheduling appointments. In total, 409 Tele-Retina appointments were booked, with 217 individuals assessed for retinopathy. Retinopathy was detected in approximately 29% of those screened, spanning mild to severe disease.

 

Implications: Leveraging administrative data enables community practices to identify individuals with diabetes who require DRS, supporting vision loss prevention through integrated care. Multi-modal outreach enhances awareness and uptake. Making DRS status accessible to community providers promotes continuity of care and alignment with clinical guidelines.