Transcript Personalised Eye Consultation (PEC) to improve outcomes in DR Dr Eva Fenwick (Research Fellow) Behavioural Research in Ophthalmology Prue Spencer, Project Manager.

Personalised Eye Consultation (PEC)
to improve outcomes in DR
Dr Eva Fenwick (Research Fellow)
Behavioural Research in Ophthalmology
Prue Spencer, Project Manager
Behavioural Research in Ophthalmology Unit
Four main themes:
1.
Prevention and management of eye
diseases
2.
Development of new patient-centred
outcome measures
3.
Development and evaluation of
interventions to improve patientcentred outcomes
4.
Translating our research into policy and
practice
Study Rationale
Relative risk
• For every 1% reduction in blood glucose there is a
25% reduction in microvascular complications
20
18
16
14
12
10
8
6
4
2
0
Retinopathy
Nephropathy
Neuropathy
Microalbuminuria
6
7
8
Source:
9
HbA1c %
10
11
Diabetes Control and
Complications Trial Study Group
(1995) Diabetes, 44: 968-83
12
• NHMRC guidelines state that helping people to
improve glycaemic control is essential to reduce risk
and progression of diabetic retinopathy (DR)
Patients at RVEEH
• Only 14% achieve optimal
blood glucose control
(Wong et al., 2009)
• Those with DR are 3x more
likely to have suboptimal
blood glucose control
• Only 17% correctly
understood the meaning of
the HbA1c test (Wang et al.,
2008)
• 57% rated blood glucose
control as important for eye
health (Wang et al., 2008)
Understanding of DR
Patients with DR: (Fenwick et al, 2013)
“I was just in this fool’s paradise, I’m just diabetic, oh background retinopathy
there’s nothing to worry about, and then all of a sudden your eye’s full of
blood and there’s plenty to worry about”
“I don't know how exactly you get eye problems [from diabetes]. I can fix cars but
I can't fix human beings”
Retinal specialists: (Fenwick et al, 2013)
“My experience is that almost no person with diabetes who ends up with vision
loss has a correct understanding of what happened”
Lack of support in diabetes management
•
•
•
Half Australians have
never been offered
structured diabetes
education.
For those that have, the
majority only offered this
at diagnosis.
Many diabetes education
initiatives fail to improve
blood glucose control.
Our approach
• Incorporate evidencebased behaviour change
techniques alongside
routine consultations.
Personalised Eye
Consultation
Personal Retinal
Image
Individualised
behaviour change
techniques
Retinal images
Healthy retina
Mild non-proliferative DR
Moderate non-proliferative DR
Proliferative DR
Study Aims
Aim 1: To assess the effectiveness of PEC on clinical and
behavioural outcomes.
Aim 2: To determine factors associated with improved
clinical outcomes and identify mechanisms of change.
Aim 3: To determine the cost-effectiveness of PEC.
Primary outcome: HbA1c
Secondary outcomes: cognitive, behavioural and psychological
outcomes
Assessment schedule: 3-, 6- and 12-months follow-ups.
Inclusion criteria:
• Type 2 diabetes
• Mild/Moderate
NPDR
• Suboptimal
HbA1c (≥8%)
• No previous
treatment for DR
• 18 years or over
• No cognitive
impairment
• English speaking
Project significance
Our Personalised Eye Consultation:
• Addresses urgent need to assist patients with DR to
achieve optimal blood glucose levels and avoid vision
loss.
• Can fit alongside routine eye consultations and could
be administered by a range of allied health
professionals.
• Provides a far reaching and accessible approach.
• Has wider application to other diabetes related
conditions or other chronic disease.
• Do you have Type 2 diabetes
and early stage DR?
• Would you like to be involved
in the trial?
• Do you know anyone who
would be interested in
participating?
• Talk to Prue today!!
Principle Investigator
Gwyn Rees:
[email protected]
9929 8048
Prue Spencer:
[email protected]
9929 8174