58-OR: Screening for Diabetic Retinopathy Increases by 32% with Education and Intervention Program in Primary Care

Introduction: Despite recommendations by the ADA and other medical societies, screening for diabetic retinopathy (DR) is suboptimal. We introduced an initiative at Penn Medicine Lancaster General Health (LGH) that included education of primary care providers (PCPs) and their patients with diabetes and installation of tele-retinal imaging service at the LGH PCP’s office.

Methods: PCPs at LGH and nationally were invited to participate in an online education program to reinforce knowledge of DR risk factors, screening recommendations, and treatments. Simultaneously, an order set for all patients with T2D presenting to the clinic was added to the EMR and retinal cameras fitted with technology for remote reading by retina specialists were installed in 34 LGH PCP clinics where staff was instructed on the use of these cameras and advised to recommend screening for patients with diabetes who did not have a diagnosis of retinopathy and were not screened in the past two years. Designated referral coordinators were assigned in each office to facilitate referrals to retina specialists when indicated by the reading retina specialist.

Results: Screening for DR increased by 32%, from 37.7% to 50.1%, with greater increases in people who were Hispanic (75.2% vs 25.6% for non-Hispanic), younger (55.6% for 18-54 yrs vs 21.4% for > 77 yrs), and with lowest and highest initial A1C (38.5% and 38.7% vs 25.3% for <6.3, >8.4, and 6.9-7.4, respectively). Overall, 760 people were screened with the camera; DR was identified in 40.1%, with other abnormalities (eg, glaucoma) identified in additional 12%. Inadequate images were captured in 19%. In addition, PCP knowledge increased significantly by 40%.

Conclusion: Installation of cameras equipped with technology to securely send images to retina specialists, along with patient and clinician education, enabled patients with diabetes to undergo guideline-recommended screening in the office of their PCP, overcoming barriers to care.