Call and recall: Who does what and when on the screening pathway

Good screening programmes track the quality of care provided and maintain key standards. After each screening and grading event, failsafe processes ensure that the required next steps on the pathway take place by:

• Communicating the results of screening with the person with diabetes and their medical doctor
• Ensuring timely referral for further investigations for those who need it
• Tracking all referrals for treatment
• Ensuring timely treatment appointments
• Maintaining timely (e.g. annual) screening intervals for recall
• Regularly collecting data on people who are blind from diabetic retinopathy (DR) for low vision services.

Below are short extracts from the recent Diabetic Retinopathy Barometer Report which highlighted the key challenges faced in implementing and managing screening services:

• The lack of guidelines, standards of care and protocols
• Gaps and barriers to referral.

The lack of locally appropriate guidelines and protocols

“The gap in access to, or application of, protocols and guidelines across all types of providers was serious and significant. Of particular concern was the finding that less than half of the providers either did not have access to protocols or, for some, the protocols available were not used.”

“The lack of written protocols and important guidelines relating to the diagnosis and treatment of diabetic eye disease must be of primary concern, particularly amongst providers who may not have the required training and experience.”

Gaps and barriers to eye care and referral

“The study also revealed barriers that were related to provider capacity such as: long waiting times to schedule an appointment with a specialist, the length of waiting time required in the clinic on the day of the visit, limited availability of necessary health services, and the distances to available services.”

“We are trying to draw their attention to the need of periodic ophthalmologic examinations. But unfortunately, we do not succeed 100% every time. A lot of our patients do not understand why they should come, even if they do not have anything with their eyes. “Why should I come?” they ask us. “Nothing upsets me,” they say.”
Ophthalmologist, Romania

In this video we introduce the call and recall system used to manage DR screening. As you watch, reflect on your own setting. Is there a guideline on call and recall intervals available or a system in place already? If not, how could one be set up? What are the main challenges that are, or are likely to be, encountered in managing a call and recall system in your setting?