A Global Compendium of Good Practice
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INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE 2018 INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE Contents Acknowledgement 5 Evidence-based leaflet to promote uptake Acronyms 6 of retinal screening among young adults Why this report 7 in Australia 19 Introduction 9 Preventing Blindness from Diabetic Retinopathy and Other Diabetes-Related Integration –What do we mean Eye Diseases in Armenia 23 and what does it look like? 11 Comprehensive, integrated diabetes care 1. INTEGRATION OF EYE CARE INTO for children in Bangladesh 27 ROUTINE DIABETES CARE/PRIMARY CARE 12 A successful integration of DR into 2. INTEGRATION OF DIABETES INTO comprehensive, county-level eye care in COMPREHENSIVE/PRIMARY EYE CARE 12 rural China 31 3. HORIZONTAL AND VERTICAL Reduction in Blindness in the English INTEGRATION OF SERVICES 12 County of Gloucestershire 33 4. INTEGRATION OF DR POLICIES, Diabetes eye care awareness training GUIDELINES AND TRAINING INTO ALL for primary level clinicians in Fiji 37 RELEVANT NATIONAL HEALTH POLICIES, Integrated Models of Care for Diabetic AND GUIDELINES 12 Retinopathy in India 41 Guiding Principles for Integrated Addressing Diabetic Retinopathy in Indonesia 45 Diabetes and Eye Health Care 15 Modelling a Telemedicine Screening Program People-centred care 15 for Diabetic Retinopathy and Implementing Equity 15 a Pilot Project in Iran 49 Quality 15 Screening for Diabetic Retinopathy in México, Collaboration 16 Telemedicine: Pilot Project 53 Evidence Base 16 Integrated Approaches to Address Diabetic Cost Efficient 16 Retinopathy in three Districts of Pakistan 57 Recommendations 16 Comprehensive Model of Diabetic retinopathy Management in the Palestinian Territories 61 Recommendations for Primary Health Care Providers: Preventative Action, Implementing an Integrated Diabetic Improved Results 16 Retinopathy Health System Model in La Libertad, Peru 65 Recommendations for Secondary & Tertiary Care Providers: Working in Evidence-Based Shared Care Eye Model: Collaboration to Overcome Barriers 17 Right Siting Of Stable Diabetic Retinopathy Patients To Primary Eye Clinic In Singapore 69 Recommendations for Government: Driving Change, Exerting Influence 17 Upscaling of diabetic retinopathy screening in Tanzania 73 Recommendations for Donors, Funding and Investment Partners: Financing for Impact 18 Diabetic eye health care model of integration at the inter and intraprofessional levels at International Case Studies of Integrated a community health center in the US 77 Care for Diabetes and Eye Health 19 Diabetic retinopathy screening and treatment in Zambia 81 DR Screening event at the Standard Chartered Bank head office in Nairobi, Kenya 2 3 INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE 2018 Acknowledgement ‘Integrated care for diabetes and eye health: The Leadership Group of the initiative would Recommended A global compendium of good practice’ has like to thank the contributing authors of the Citation been developed by the partners of the Global case studies presented in the compendium Diabetic Retinopathy Advocacy Initiative. for their time spent developing this important Global Diabetic content and for their collaboration with the Retinopathy The initiative is a multi-agency advocacy compendium authors. Advocacy Initiative. project being undertaken by leading non- Integrated care for government agencies in the diabetes and eye The compendium was written and compiled diabetes and eye health sectors from 2017-2018. The current by The Fred Hollows Foundation. For more health: A global Leadership Group for the initiative includes: information please contact the Global compendium of good The Fred Hollows Foundation; Helen Keller Partnerships and Advocacy Division, The Fred practice. Melbourne, International; The International Agency for Hollows Foundation [email protected] Australia, 2018. the Prevention of Blindness; International Council of Ophthalmology; International Note: Photos have been used with the Diabetes Federation; Lions Clubs International permission of the case study authors and or Foundation; Orbis International; Sightsavers provided by The Fred Hollows Foundation International; The Queen Elizabeth Diamond Jubilee Trust; World Council of Optometry; and in association with the World Health Organisation. Disclaimer: Case studies presented in this compendium were selected following an international call for expressions of interest and reflect an intention to provide readers with brief examples of programs from a broad range of contexts. Inclusion of individual case studies in this compendium does not reflect endorsement by the initiative or individual partners on the validity or efficacy of works either in part or as a whole nor should it be read as a statement Hospital screening for DR in the Pilbara region of Western Australia. Photo: Alan McDonald on the success or otherwise of each program in achieving health outcomes. 4 5 INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE 2018 Why this report ACRONYMS As global awareness of Diabetic Retinopathy Drawing on evidence from a range of (DR) has increased so too has the projects and programs showing promising Frequently used acronyms throughout the Compendium development of resources and tools to assist results from 17 countries, the document will health care providers in the early detection provide guidance to policy makers, medical and treatment of this growing public health organisations, service providers and social DR Diabetic Retinopathy problem associated with the rising prevalence investors. of diabetes. However, few of these resources The intended outcome is that decision makers DR-NET Diabetic Retinopathy Network have focused on providing insight into innovative approaches to integrating eye and practitioners will be able to build on the findings and learnings presented in this report DM Diabetes Mellitus health with diabetes management and control, across the health care spectrum. to implement their own strategic and tactical approaches to addressing the challenges DME Diabetic Macular Edema For this reason the ‘Integrated care of blindness and vision loss from diabetes. for diabetes and eye health: A global Ultimately, it is our hope that those living with GP General Practitioner compendium of good practice’ has been or at risk of DR around the world will be able developed. It documents a series of ‘real- to access the support they need, when and IDF International Diabetes Federation world’ case studies that showcase current where they need it. initiatives to advance integrated care for DR LMIC Low to middle income country across the spectrum of health promotion, prevention, early intervention and treatment MoH Ministry of Health (relative to specific country) in a range of different contexts and resource settings. NCD Non-Communicable Disease The compendium has been designed to help PHC Primary Health Centre fill a crucial knowledge gap and to strengthen the existing evidence base through providing PWD People with diabetes insights on a range of different models, lessons learned and key recommendations on STDR Sight Threatening Diabetic Retinopathy how to effectively implement integrated care. WHO World Health Organisation 6 7 INTEGRATED CARE FOR DIABETES AND EYE HEALTH A GLOBAL COMPENDIUM OF GOOD PRACTICE 2018 Introduction High Level Summary All seventeen case studies presented in this compendium have been mapped against integration type. Many of these case studies reflect multiple approaches to integration articulated within this report. CASE STUDY COUNTRY REGION PRIMARY INTEGRATION TYPE SUBMITTING ORGANISATION(S) Integration of eye care into The Australian Centre for Evidence-based leaflet to promote uptake East Asia & Australia routine diabetes care/primary Behavioural Research in of retinal screening among young adults Pacific care Diabetes Preventing Blindness from Diabetic Diabetic eye disease refers to a group In order to address this escalating epidemic, Europe & Horizontal and vertical Retinopathy and Other Diabetes-Related Armenia Armenian EyeCare Project of conditions affecting the structure or a coordinated and collaborative response is Central Asia integration of services Eye Diseases function of the eye, and are associated with required so that prevention, early detection Integration of eye care into or result as complications of long-standing and timely treatment of DR becomes an Comprehensive, integrated diabetes care Bangladesh South Asia routine diabetes care/primary Orbis International for children diabetes. These include cataract, glaucoma, integral part of the ongoing primary care care refractive error and loss of focussing ability of PWD, and that well-defined and effective A successful integration of DR into Integration of diabetes care East Asia & (accommodation), nerve involvement such as referral pathways to specialist care are comprehensive, county-level eye care in China into comprehensive/primary Orbis International Pacific rural China eye care ischemic optic neuropathy and ocular nerve established for those who need further palsies resulting in double vision but most examination and treatment are accessible, Integration of diabetes care Reduction in Blindness in the County of Europe & Gloucestershire Diabetic Eye England into comprehensive/primary importantly, diabetic retinopathy (DR), which affordable and of good quality.