Five regions, five retinopathy screening programmes: a systematic review of how Portugal addresses the challenge

Andreia Marisa Penso Pereira,Raul Manuel Da Silva Laureano,Fernando Buarque De Lima Neto

doi:10.1186/s12913-021-06776-8

Abstract

BackgroundThe implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes, and difficulties. However, factors such as the existence of regional programmes, specificities of each country’s health systems, organisational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects.MethodsWeb of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organisations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed.ResultsSince 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading, and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening.ConclusionAccess to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics.Trial registrationPROSPERO registration ID CRD42020200115.

Highlights

The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs
The share of knowledge and experiences between countries is of recognised utility, and there is a permeant need for a solid framework, that can be used as a basis for future projects [5, 18, 20]
National guidelines should precise the role of the different intervenient, and politic measures should be created to guarantee the involvement of all parts

Summary

Introduction

The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. It is of the utmost importance to promote the sharing of experiences, successes, and difficulties Factors such as the existence of regional programmes, specificities of each country’s health systems, organisational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Extremely important, the implementation of a population-based DR screening, requires the intervention of many stakeholders (government, hospitals, primary health care units) and involves numerous challenges, which often lead to unexpected setbacks at high human and material costs [18, 19]. Different countries often have different health systems, which makes it difficult to understand and categorise procedures [5, 21], screening programmes may be implemented at a national, regional, or local level, resulting in sparse information at a national level, and there are organisational and even linguistic barriers, that complicate the process [18, 20]

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