PURPOSE: This project evaluates the change in completion percentage of annual diabetic retina screenings using an inexpensive smartphone retina camera in an urban family practice. 58.7% is the goal defined by HealthyPeople 2020 Midcourse Review released in 2016 for annual diabetic retina screening. The study practice had a completion rate of 34% in May 2017.
EBP QUESTIONS: Will implementing the nurse practitioner lead smartphone retinal screening protocol increase completion rates of diabetic retina screening? Do patients complete annual eye or retina specialist referrals at a higher rate if a retina scan result is not normal? Can a nurse practitioner providing a convenient retina scan change a patient’s self-efficacy and empowerment?
METHODS: This project study uses a quasi-experimental design convenience sample with a pretest and posttest survey, The Diabetes Empowerment Scale, developed by in 2000 and revised to an 8 question short version in 2003. The telehealth intervention is the D-EYE smartphone ophthalmoscope. Subjects are current diabetic patients, over 18 years old, who had selected the center as their primary care. Recruitment occurs over 3 months with a short explanation of the study, consent, survey and retina scan completion. The nurse practitioner contacts the patient and initiates a referral. Four weeks post referral the patient will be contacted to validate the follow-up and complete the post survey.
OUTCOMES: It is anticipated that post study results will demonstrate retina screening percentage increase exceed the HealthyPeople 2020 goal of 58.7%. Poor retina screening results will result in higher numbers of completed eye speciality referrals. Patients who have lower empowerment survey scores will have higher empowerment scores post intervention.
SIGNIFICANCE: This project empowers the nurse practitioner with an affordable telehealth tool to bridge the gap in diabetic patients completing their annual retina scan. Utilization of telehealth increases completion of diabetic retina screening. Early identification of conditions that cause blindness in this high-risk population leads to timely referrals to eye specialist and early intervention. Patients identify self-efficacy through early knowledge while reducing the barrier of convenience to screening. Employers, families and patients have reduced financial and emotional stress related to the sequela of blindness if diabetic retinopathy is not caught early enough to treat. Exceeding the goal of 58.7% from HealthyPeople 2020 by screening 100% of the population and incorporating eye screens in to family practice as easily as blood pressure evaluations.