Challenges in Establishing a Diabetic Retinopathy Screening Program in Northern Quebec

Theme: Global and public health ophthalmology
What: Global and public health ophthalmology
Part of: CAPHGO: Global Eye Care - Challenges beyond VISION 2020 with 2030 in Sight / CAPHGO: Soins oculaires mondiaux Défis au-delà de VISION 2020 avec 2030 en ligne de mire
When: 6/2/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 B

Abstract

Purpose:

Indigenous populations, such as those in Canada, face a significantly higher prevalence of type-2 diabetes, with rates 3 to 5 times higher than the general population. Various factors, including genetic predisposition, environmental factors, poverty, limited resources, and multiple barriers, such as geographical isolation, education disparities, employment challenges, and cultural and linguistic differences, contribute to the disproportionate impact of diabetes on Indigenous communities. Notably, Indigenous individuals are diagnosed at a younger age, exhibit more severe diagnoses, experience higher rates of complications, and achieve poorer treatment outcomes.

Over the last two decades, advances in digital fundus photography have improved both image quality and device portability, enhancing DR screening in remote areas where diabetic patients reside. Despite the presence of trained professionals from Montreal willing to travel to Northern Quebec, several challenges impede the implementation of an effective DR screening program.

Our goals are to identify and elucidate the barriers hindering the successful implementation of a diabetic retinopathy screening program; and to quantify the number of patients scheduled for screening versus those who actually attend their appointments.

Study design: descriptive study.

Methods:

This project involves diabetic patients of all age groups residing in the 14 villages of Northern Quebec. The screening program for diabetic retinopathy entails dispatching ophthalmologists or nurses from the McGill Academic Eye Centre in Montreal to Northern Quebec. Fundus images are obtained using a mobile retina camera (Visuscout® 100 from Zeiss) and analyzed for the presence or absence of diabetic retinopathy. Essential components include access to office space within a hospital or clinic, an appointment scheduling assistant, a local nurse to assist with patient flow, and a translator.

Results:

Visits to Northern Quebec faced cancellations due to various reasons, including a lack of available office space due to concurrent specialist presence, insufficient personnel to contact and schedule patient appointments, a shortage of local nurses to assist during appointments, and an absence of translators. Between March and August 2023, three visits occurred, with 119 patients scheduled for screening, of which 45 (37.81%) were absent.

Conclusion:

Barriers for patient attendance at scheduled appointments are multifactorial. These include a large geographic distance, limited examining room space, limited nursing and administrative personnel and limited translators.

Presenter(s)

Presenting Author: Jacqueline Coblentz

Additional Author(s):

Bryan Arthurs, McGill University

Christian El-Hadad, McGill University

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