Diabetic Retinopathy Screening in Private Practice

Study Overview
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Brief Summary
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Introduction: Diabetic mellitus (DM) is a prevalent disease in Hong Kong (HK) and diabetic retinopathy (DR) is one of the most common complications of DM. Screening for DR is a cost-effective method to identify patients who are at risk of vision loss so that timely treatment can be provided to patients. In Hong Kong, the Hospital Authority has recently set up screening services (RAMP) in the government outpatient clinics and all DM patients attending these clinics will be screened at least once every two years and some every six months, according to their individual risks. However, those diabetic patients who attend the private sector for their primary care may not have access to this service. Aim: This study from the University of Hong Kong aims to determine the characteristics of a sustainable approach to setting up an effective and quality-controlled screening service for DR in the private primary care sector of Hong Kong and to estimate the potential benefit to be gained in terms of impact on avoidable vision loss, costs of care and potential for further development of this model in chronic disease care. Methods:A screening centre is being set up and a randomised study carried out in which screening will be offered at three different fee levels to subjects recruited by their general practitioner (GP). The following data will be collected (a) willingness to attend screening at the different fee levels (b) screening findings in terms of DR and other eye diseases (c) risk factors and other characteristics of those screened and unscreened. The information will allow us to estimate the level of fee which best combines effectiveness with sustainability in the longer term.

Official Title
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The Feasibility of Screening for Diabetic Retinopathy in Private Practice Hong Kong

Conditions
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Diabetic Retinopathy

Intervention / Treatment
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* Other: Free screening group
* Other: Pay screening group ($150)
* Other: Pay screening group ($300)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed to have diabetic mellitus Able to give informed consent Exclusion Criteria: Pregnant women

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Free screening group<br>Subjects in this group receive free diabetic retinopathy screening. | Other: Free screening group<br>* The intervention provide Diabetic Retinopathy screening without charging a fee.<br>|
| Active Comparator: Pay screening group ($150)<br>Subjects in this group receiving diabetic retinopathy screening will be charged HK$150. | Other: Pay screening group ($150)<br>* The intervention is charging HK$150 for the Diabetic Retinopathy screening.<br>|
| Active Comparator: Pay screening group ($300)<br>Subjects in this group receiving diabetic retinopathy screening will be charged HK$300. | Other: Pay screening group ($300)<br>* The intervention is charging HK$300 for the Diabetic Retinopathy screening.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The overall, & at different fee level, uptake (as a percentage of participants) of screening from those at-risk patients who attend private GP's |  | one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of participants with diabetes who are only under the care of a private GP, or also attend specialist service, and have had access to DR screening |  | one year | 
| Prevalence of DR (overall, and for sight-threatening diabetic retinopathy) among diabetic patients in private primary care |  | one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetic Retinopathy, Screening, Fee for screening, Private practice