Use and adequacy of diabetic retinopathy screening: a whole population linked data study

糖尿病及其并发症是澳大利亚目前面临的主要公共卫生问题。目前，约7%的澳大利亚人患有糖尿病，据估计，20年内将有3亿人患有糖尿病。糖尿病的一个主要并发症是糖尿病视网膜病变，这是导致工作年龄成年人失明的最常见原因。虽然早期治疗可以防止糖尿病视网膜病变导致的视力丧失，但通常在病情发展到晚期和难以治疗时才会出现视力症状。因此，糖尿病患者定期检查眼睛是至关重要的。我们的目的是调查糖尿病患者使用眼科服务的情况。西澳数据联动系统提供了独特的机会，有效地检查西澳17年期间糖尿病患者的专科眼科护理的好处。研究期间包括1997年引入的NHMRC糖尿病视网膜病变筛查指南。这将使我们能够检查这些指南在增加糖尿病患者使用眼科服务方面的有效性。评估这些趋势将为政策和NHMRC指南在改善糖尿病眼保健方面的有效性提供重要数据，这一点从未得到全面调查。早期干预可以预防和延缓糖尿病视网膜病变导致的视力丧失，大大减少糖尿病给个人和社区带来的负担。识别筛选不良的群体将使更有针对性的项目能够改善眼科系列的使用，这反过来可能降低以下风险：1)与糖尿病相关的眼科手术，2)与糖尿病相关的视力障碍造成的损伤或3)失明。利用关联健康数据评估糖尿病患者眼部筛查的可行性，将使今后处理预防其他糖尿病并发症的护理过程的工作能够迅速和经济有效地开展。

Diabetes and its health complications are major public health issues presently facing Australia. Currently, around 7% of Australians have diabetes and it is estimated that 300 million people will be diabetic within 20-years. One major complication of diabetes is diabetic retinopathy, which is the most common cause of blindness in working-age adults. Although early treatment can prevent vision loss from diabetic retinopathy, often there are no visual symptoms until the condition is more advanced and less treatable. Consequently, it is vital that people with diabetes have their eyes examined regularly. We aim to investigate the use of eye services by people with diabetes. The WA Data Linkage System provides the unique opportunity to efficiently examine the benefits of specialist eye care in diabetics within WA over a 17-year period. The study period encompasses the introduction of NHMRC guidelines for diabetic retinopathy screening in 1997. This will enable us to examine the effectiveness of these guidelines in increasing ophthalmic services use by people with diabetes. Evaluating these trends will provide important data on the effectiveness of policy and NHMRC guidelines in improving diabetic eye care, which has never been comprehensively investigated. Early intervention can prevent and delay vision loss from diabetic retinopathy, substantially reducing the personal and community burden from diabetes. The identification of poorly screened groups will enable more targeted programs to improve the use of ophthalmic series, which in turn may reduce the risk of: i) eye surgery related to diabetes, ii) injury resulting from diabetes-related vision disorder or iii) blindness. The feasibility of using linked health data to evaluate eye screening in diabetics will enable future work addressing processes of care in the prevention of other diabetic complications to be undertaken quickly and cost-effectively.