Continuing medical education on diabetes by primary care physicians

Knowledge and practices of fundoscopy among general practitioners in Qassim Province, Saudi Arabia, for the management of diabetic retinopathy and diabetic macular edema: A cross-sectional study

Objectives:

Blindness is one of the most widespread final pathways of diabetic retinopathy and its associated diabetic macular edema. The general practitioners are the first to encounter these diabetic patients. Fundoscopy is now considered as an ideal way for the diagnosis of patients with diabetic retinopathy. Therefore, this study was undertaken to know the ability and skills of general practitioners for the diagnosis and management of patients with diabetic retinopathy and diabetic macular edema.

Methods:

This study was conducted in all major cities in Qassim province of Saudi Arabia during January to May 2017. A validated questionnaire was used to assess the general practitioners’ knowledge and practice for the management of diabetic retinopathy and diabetic macular edema. Questions related to referrals, diagnosis, and treatment options to diabetic retinopathy and diabetic macular edema were asked to the general practitioners.

Results:

Of 96 general practitioners, 76 returned the questionnaire with a response rate of 79.2%. Only 26.3% general practitioners referred patients with type 1 diabetes to ophthalmologists as per guidelines set by the American Academy of Ophthalmology, whereas 74% of general practitioners showed good knowledge for referring patients with type 2 diabetes to ophthalmology clinics. Lack of knowledge was also noticed for the treatment of diabetic retinopathy, as only 36.8% of general practitioners replied positive for dilated fundus examination option, whereas 78.9% of general practitioners chose laser photocoagulation as a treatment option. Similar response from them was observed for patients with diabetic macular edema. Furthermore, data also showed years in practice of general practitioners was well correlated with their knowledge for the management of diabetic retinopathy and diabetic macular edema.

Conclusion:

The general practitioners included in this study showed lack of knowledge in handling patients with diabetic retinopathy and diabetic macular edema. Therefore, refresher courses are needed that highlight the acquisition of their skills in fundoscopy.

Diabetic retinopathy: Knowledge, awareness and practices of physicians in primary-care centers in Riyadh, Saudi Arabia

PURPOSE

Diabetic retinopathy (DR) is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. As primary care physicians (PCP) are the main providers for diabetic care in Saudi Arabia, we aim to evaluate the current knowledge and awareness, and to assess practices among PCP regarding DR.

METHODS

We conducted a cross-sectional study covering 46 randomly selected primary-care centers in Riyadh during October 2015. A Self-administered questionnaire was distributed to PCP containing 3 sections. The first section covered participants' demographics and professional background. The second section contained multiple-choice questions on knowledge related to diabetes and DR. The third section was to assess physicians' practices.

RESULTS

A total of 216 PCPs completed the questionnaire. The mean overall knowledge score was 57 ± 14 out of 100. There was a significant difference in knowledge score between physicians who had obtained a subspecialty degree in family medicine compared to others (59 ± 14, 53.3 ± 14 respectively; P = 0.003). Only 19% of PCPs were aware of anti-vascular endothelial growth factor (VEGF) injections as a modality of treatment. A defect was found in the screening and follow-up of type 1 diabetics, and only 24% of physicians correctly referred patients with type 1 diabetes to an ophthalmologist.

CONCLUSION

Our study uncovered areas of defects in knowledge among PCP regarding DR. This needs to be addressed in future seminars and workshops with an emphasis on the proper ophthalmological screening and management of diabetic patients.

The GP perspective: problems experienced in providing diabetes care in UK general practice

AIMS

To describe the problems and barriers perceived by general practitioners (GPs) whilst providing diabetes care in primary care in England and Wales and to identify those health authorities (HAs) in which primary care reported the most and least difficulty.

DESIGN

Descriptive postal survey using a self-administered questionnaire.

SUBJECTS

One thousand eight hundred and seventy-three randomly sampled GP practices (one in five practices).

RESULTS

One thousand three hundred and twenty (70%) responded. Getting patients to alter their lifestyles was perceived as causing the most difficulty in managing individual patients, followed by lack of time, patients' nonattendance, noncompliance with medical regimens and poor communication with secondary care. The greatest barriers to practices providing desirable care were lack of time/under-funding and keeping up to date in the area of diabetes, followed by lack of space, inadequate chiropody, dietetics, ophthalmology and access to secondary care. There are important differences between HAs in the difficulties experienced by primary care teams and we have ranked the HAs accordingly.

CONCLUSION

The study has identified what problems need tackling in order to assist primary care to deliver good quality diabetes care, and has highlighted HAs where primary care needs further help, and HAs where examples of good practice may be found and useful lessons learnt. This should form the basis of a needs-based research and development programme for diabetes in primary care.

Transfer of preventive health programs to physicians' practices through medical organizations

BACKGROUND

Transferring new information to practicing physicians is a complex and often faulty process. Effective transfer is a challenging goal that requires a strategy for reaching large numbers of physicians throughout the country in a short time. However, methods for disseminating preventive health techniques such as smoking cessation have not been well organized. Smoking is the single most important preventable cause of premature mortality, so dissemination of research-based smoking-cessation techniques to physicians' practices is a priority for the National Cancer Institute (NCI).

METHODS

NCI recruited national, professional medical organizations to collaborate in disseminating smoking-cessation techniques. The goal was to co-sponsor 50 Train-the-Trainer (TT) seminars that would prepare 2,000 professionals as volunteers to instruct their colleagues in smoking-cessation techniques. NCI provided all materials, faculty (nine professionals), advance logistics, CME credits, and follow-up. The co-sponsor organizations helped develop the training plan, promoted training among their members, enrolled professionals to be trained, and made logistical arrangements for the training sites.

RESULTS

During the 4 years of the program, NCI recruited 11 national organizations as co-sponsors; conducted 53 TT seminars in 22 states and Washington, DC; and trained 2,098 professionals as smoking-cessation trainers, who practice nationwide. The many lessons learned provide the basis for recommendations that can assist others who want to work with professional organizations.

CONCLUSION

The National Cancer Institute demonstrated that national organizations of medical professionals can help to disseminate effectively a research-based smoking-cessation program. Twelve recommendations are presented to help others disseminate preventive health techniques nationwide.