Stakeholders’ perspectives on the management of diabetic retinopathy for a district health system – South Africa

Kovin Naidoo ,Linda Visser,Zaheera Abdool

doi:10.4102/aveh.v76i1.412

Abstract

Background: Clinical practice guidelines for the management of diabetic retinopathy (DR) adopted in various countries show variations in methods of examinations, screeners and classification systems. The South African National Guidelines for the frequency of referral of patients with diabetes mellitus (DM) for DR assessment were developed more than a decade ago. They do not specify the role of primary healthcare workers (PHCW) to manage DR at primary healthcare (PHC) level. The primary objective of this study was to establish the current role of PHCW in managing diabetic eye disease.Method: A cross-sectional study was conducted, and questionnaires were distributed to a total of 181 healthcare practitioners (HCPs) in public health institutions situated in the northern eThekwini district of KwaZulu-Natal. Clinics and community health centres (CHCs) were selected based on the assumption that PHC nurses, general practitioners or medical officers (MOs) and ophthalmic nurses practice at these institutions. The hospitals selected were the referral institutions for the selected clinics and CHCs. The questionnaires distributed included questions relating to the DR classification systems usage, HCP interaction and opinions on how HCPs could be valuable in managing DR.Results: Only two out of the five ophthalmic nurses were familiar with the grading classification systems for DR. Ophthalmic nurses had less interaction with general practitioners or MOs (40.0%) than the PHC nurses (60.0%). Only 2.4% of the PHC nurses interacted with ophthalmologists. Four of the five ophthalmic nurses indicated that PHC nurses would be valuable in the management of DR by taking visual acuity (VA) and conducting a pinhole test. More than 60% of the general practitioners or MOs (65.6%) suggested that ophthalmic nurses do a fundus examination. Ophthalmologists indicated that the PHC nurses were the least capable (17.7%) to screen for DR.Conclusion: Primary healthcare workers such as PHC nurses, ophthalmic nurses, general practitioners or MOs and optometrists have specific roles to play in DR management, which includes its prevention, detection, grading, referral and monitoring.

Highlights

Diabetic retinopathy (DR) is a retinal microangiopathy which can be caused by long-standing[1,2,3] and or uncontrolled diabetes mellitus (DM).[2,4]
The purpose of this study was to determine the current status of the referral pathway for patients with DM and to prevent, detect and manage DR at each level of care by various healthcare practitioners (HCPs) based on recommendations made by different stakeholders
Four of the five ophthalmic nurses indicated that primary healthcare (PHC) nurses would be valuable in the management of DR by taking visual

Summary

Introduction

Diabetic retinopathy (DR) is a retinal microangiopathy which can be caused by long-standing[1,2,3] and or uncontrolled diabetes mellitus (DM).[2,4] Regarded as a global pandemic, the prevalence of DM amongst the adult population (20–79 years) is 8.5% worldwide, affecting 25 million adults in the African Region[5] and 2.6 million adults in South Africa (SA).[6]. Diabetic retinopathy in its initial stages (non-proliferative) may be asymptomatic but can lead to irreversible vision loss if poorly managed.[1] Treatment options depend on the severity of the DR and the presence or absence of diabetic macula oedema (DME). The South African National Guidelines for the frequency of referral of patients with diabetes mellitus (DM) for DR assessment were developed more than a decade ago They do not specify the role of primary healthcare workers (PHCW) to manage DR at primary healthcare (PHC) level. The primary objective of this study was to establish the current role of PHCW in managing diabetic eye disease

Objectives

Methods

Results

Discussion

Conclusion