The retinal screening in diabetic patients：one-stop service model

• Main Authors: Chii-Chang Yeh, 葉啟昌
• Other Authors: Da-Chen Chu
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/f6v262

碩士 === 國立陽明大學 === 醫務管理研究所 === 106 === Diabetic retinopathy is the leading cause of blindness among working-age adults. Statically speaking, DM patients who have 5 years illness could have 20% of varying degree retinopathy; 10 years illness, the incidence could rise to 60%; 20 years illness, could be 90%. In general, the blindness incidence rate of diabetic patients could be 25-fold of non-diabetes. As a result, ways of detecting early retinopathy for the diabetic patients should be addressed. In the early days, retinal screening for the diabetic patients all should be referred to ophthalmology clinic, mydriatic fundus photography and eye doctor direct ophthalmoscopy were employed, but patients were not fully cooperative and took less examinations; these should be improved with new examination and ways of service. The subjects being investigated for this study are diabetes outpatients at a regional teaching hospital in the north, Endocrine & Metabolism division from 2015 to 2017. In order to early detect retinopathy, the Endocrine & Metabolism division developed one-stop service model for retinal screening and purchased indirect non-mydriatic fundus photography on Sep. 1, 2016. The previous one year from the critical date(Sep. 1, 2015～Aug. 31, 2016), there are total 1229 diabetes outpatients；one year after the critical date(Sep. 1, 2016～Aug. 31, 2017), there are total 1170 diabetes outpatients. Previous one year to critical date, the retinal screening are performed in eye clinic, mainly by mydriatic fundus photography and eye doctor direct ophthalmoscopy；one year after the critical date, the most of the people with retinal screening are performed in diabetes education room, dominated by indirect non-mydriatic fundus photography. To compare the differences of the four testing rates between these two time spans, each one year before and after the critical date( Sep. 1, 2016), diabetes urinary microalbumin and urinary creatinine ratio(assessment of nephropathy), the ophthalmoscope examination (assessment of retinopathy), monofilament feet detection (assessment of neuropathy), and ankle-brachial artery blood flow ratio(decision to lower extremity vascular disease), screening rates are all put to examined. There are four tests as tools to screen for diabetic vascular disease, and the testing rates done for the previous year to critical date, were urine microalbumin/urine creatinine testing rates 85.5% , retinal screening 57.7% , peripheral nerve detect 86.0% , ankle-brachial artery blood flow ratio 73.9% ; one year after the critical date the testing rates were 86.0%, 72.6 %, 86.4 %, and 74.9 % respectively, it shows only the retinal screening from this four tests is statistically different (57.7% vs 72.6 %, p value < 0.01) in each one year before and after the critical date, the other three tests haven’t reached to statistical difference. One-stop service model for diabetic retinopathy is to complete all the checkups at diabetes education room, with the help of indirect non-mydriatic fundus photography, and let endocrine specialist interpreted the retinal image. If retinal image is abnormal, with doubt, or not clear, patients can be referred to ophthalmologists outpatient clinic, and many retinal lesions can be found in advance and get treated to prevent blindness happening. This innovated service should be promoted with a view to helping most diabetes.