Recommendations for implementing rheumatic heart disease echocardiographic detection in remote Australia: A narrative review and lesson-drawing from diabetic retinopathy screening.

Background and objectives: Australia has some communities with the highest rates of rheumatic heart disease (RHD) in the world. Echocardiographic detection of RHD through active case finding has been proposed for early detection. Lessons can be learnt from the implementation of a similar program - diabetic retinopathy screening. The aim of this paper is to identify transferable lessons from the implementation of diabetic retinopathy screening that could be applied to RHD echocardiographic detection.

Method: This paper presents a narrative review and expert recommendations.

Results: Transferable lessons from the implementation of diabetic retinopathy screening include training local staff regularly with formal certification; supplementary health promotion; program champions; general practitioner involvement; informing all staff at clinics; creating separate Medicare Benefits Schedule items for acquisition and interpretation; using echocardiography for detection and monitoring of RHD; establishing referral pathways and communication channels; local community involvement in implementation planning; and developing an adaptable program.

Discussion: Implementing programs successfully and sustainably in remote communities is known to be challenging. These transferable lessons from the implementation of diabetic retinopathy screening might assist in the planning of an RHD detection program.