Integrating Nursing–Teleophthalmology Improves Diabetic Retinopathy Screening in Primary Healthcare, Reducing Unnecessary Referrals to Specialist Healthcare

Abstract

Aim

This work aimed to evaluate the use of teleophthalmology by a primary healthcare nursing team for the diagnosis and referral for diabetic retinopathy to specialized healthcare in relation to numbers referred for specialized healthcare.

Methods

In this quantitative, cross-sectional service evaluation study, participants with type 2 diabetes mellitus underwent a fundoscopy examination between February and June 2020. Using a portable retinal camera attached to a smartphone, nurses acquired fundus images that were stored on a cloud platform, enabling remote reading by a retinal specialist. The study was conducted at a primary healthcare urban centre on the outskirts of São Paulo, Brazil.

Results

The study enrolled 779 participants, of whom 150 were identified as having diabetic retinopathy present; in another 434, evidence of diabetic retinopathy was absent, and 195 individuals (25%) were classified as having ungradable images. In total, 345 participants were referred for specialized appraisal, 150 of whom due to evidence of diabetic retinopathy and for another 195 participants owing to ungradable images. Thus, more than half of the imaged participants (56%) were not eligible for referral to specialist healthcare and remained treated in primary care.

Conclusions

Nursing–teleophthalmology integration reduced specialized healthcare referral numbers by more than half. This approach contributed to better triage with a more robust evaluation for diabetic retinopathy diagnostic suspicion, reducing unnecessary referral.