A training program for Primary Care Physicians enhances the effectiveness of management of Diabetic Retinopathy in India

Background

In India, more than 18% of people with diabetes suffer from Diabetic Retinopathy (DR) and nearly half of them loose vision before DR is diagnosed. Globally, one in three people with diabetes currently developing retinopathy over their lifetime. With early detection and proper management 90% of visual loss due to DR can be prevented. As per DR Barometer Global Report, 21% of the ophthalmologists had not received specific training in the treatment and diagnosis of DR and Diabetes Macular Edema. To manage this high burden and limited training specialties directed towards DR management there is a need for capacity building of Primary Care Physicians (PCPs) so that they can effectively prevent and manage DR at the primary and secondary level.

Aim

The aim of this study was to determine whether a training program targeted to PCPs could enhance the effectiveness of management of DR in a real-life setting.

Method

A total of 324 PCPs from 11 districts and 13 cities of the study were provided four modular on-the-job training in the prevention and management of DR with once in a month contact session on weekend. The evidence based course curriculum was conceptualized and delivered by Public Health Foundation of India with academic partners, Dr. Mohan’s Diabetes Education Academy and Aravind Eye Care System and vetted by national experts which later taught by endocrinologists/diabetologists & retina specialists at 13 centers and monitored by public health professionals as observers. The robust curriculum was a judicious mix of case-studies, pre-post-tests, assignments, group activities, direct teaching, hands-on-training and was supported by the strong monitoring and evaluation mechanism. Improvement in knowledge of physicians were assessed by baseline & endline questionnaire, pre-post-test scores and onsite/offsite monitoring. The evaluation was carried out with 60 participants out of 285 who had successfully completed the training in two batches.

Results

Pre-post-test scores shows significant improvement {two tailed Anova (P value < 0.05 t-test)} in knowledge regarding systemic management and prevention of DR. Baseline and endline survey of 217 participants shows 23% rise in effective management of DR. Evaluation shows 92% participants agreed that the case studies, videos, activities and hands-on-training provided were adequate for initiating discussions for replicating real life case scenarios in DR management. More than 95% of the participants agreed that the training felicitated them to do the early detection and better management of the patients with eye complications. All the participants shared that they have started the timely referral of patients with eye complications/ DR to the concerned specialist.

Discussion

The training of PCPs aimed at the prevention, management and referral of patients with DR efficiently proves that the course contributed significantly to the knowledge of PCPs in DR management & added value to their treatment skills. To increase the scalability and to improve the sustainability of the program an E- Learning Model has been envisioned to expand the reach of program at global scale.

A training program for primary care physicians enhances the effectiveness of management of diabetic retinopathy in India