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Wendy Newsom Lead Optometrist Cambridgeshire DRSS. CVi Audit Patel Gordon-Bennett (MRCOphth) Declan Flanagan (FRCOphth). Audit objectives. To obtain the rates of visual impairment registration due to Diabetic Retinopathy in the population covered by CambsDRSS
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Wendy Newsom Lead OptometristCambridgeshire DRSS CVi Audit Patel Gordon-Bennett (MRCOphth) Declan Flanagan (FRCOphth)
Audit objectives • To obtain the rates of visual impairment registration due to Diabetic Retinopathy in the population covered by CambsDRSS • To compare this rate to previous audit (2004) • To compare with National Standards
Service Objectives and Quality Assurance Standards: Release 6.5, June 2009 • Standard 1- Objective To reduce new blindness due to diabetic retinopathy • National rates in 1990/91 = SSi 9.5 per million per annum Si 9.3 per million per annum • SSi VA of 6/60 or worse in the better eye • Si VA of 6/18 or worse in the better eye
Standards • Minimum • 10% reduction within 5 years of start of screening programme • Achievable • 40% reduction within 5 years of start of screening programme. Bunce C, Wormald R. Leading causes of certification for blindness and partial sight in England & Wales. BMC Public Health. 2006 Mar 8; 6:58. SSi 13.6 per million per year in 1999/2000 Si 24.8 per million per year in 1999/2000
Methods • Retrospective review of CVi forms registered in 2007 at Cambs County Council and Peterborough County Council • Validation by review of CVi forms at Addenbrooke’s, Hinchingbrooke and Peterborough Hospitals • Data collection of patients with South Cambs, Cambridge city, Hunts, and Peterborough post codes (East Cambs and Fenland excluded) • Type of Registration • Age at Registration • Primary Cause of visual loss for registration • Post Code (1st half) + GP Post Code • Population of Cambs and Peterborough obtained from Census 2001
Demographics • Population of Cambridgeshire (excluding East Cambs and Fenland) 555,916 -CambsDRSS population • Hunts 156,950, • Cambridge City 108,879 • South Cambs 130,087 • Peterborough 160,000
Results • 315 CVi forms in 12 months • 139 (44%) SSi • 170 (54%) Si • 6 data not recorded on CVi • 21 predominantly due to DR • 7 SSi • 14 Si
Comparison with standard () • Cambs CVi registrations (2007) • SSi 12.6 per million per year (9.3) (13.6) • Si 25.2 per million per year (9.2) (24.8) • Previous Cambridgshire audit 2004 • SSi 14.4 per million per year • Si 21.3 per million per year Cambridgshire including Fenland excluding Peterborough
Local Numbers Numbers of CVi for DR 2008 SSi 11 (7) Si 19 (14) • Hinchingbrooke Hospital Huntingdon • 2007 2008 • SSi 4 SSi 2 • Si 5 Si 5 • Addenbrookes Hospital Cambridge • 2007 2008 • SSi 1 SSi 4 • Si 3 Si 5 • Peterborough District Hospital • 2007 2008 • SSi 2 SSi 5 • Si 6 Si 9
Recommendations • A good CVi audit is a large undertaking • A 5 year gap between audits would appear to be a good interval (numbers are v. small) • CVi Database should be held at the eye dept • Record postcode of both patient and GP to ensure correct boundaries for the DRS Scheme • Might be able to use the national CVi database, held at Moorfields, for verifcation of local/national figures