Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman.
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Knowledge, attitudes and practices of 40 randomly selected physicians was assessed in the North Sharqiya region of Oman in 2003. We evaluated non-ophthalmologist physicians' knowledge of techniques of eye examination of diabetic patients, attitudes towards fundus examination and practices of detailed eye examination. Knowledge about different parts of the eye was satisfactory in only 58% of physicians and knowledge about method of fundus examination for diabetic retinopathy was poor in 40%. Attitudes towards eye examination by non-ophthalmologists at primary level were positive. In practice 20 physicians had attempted to use an ophthalmoscope and only 9 could see details of the retina. Our general physicians would need detailed training if they are to be involved in early detection of diabetic retinopathy.Keywords:
Eye examination
Fundus (uterus)
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The purpose of the study was to assess the awareness of physicians in rural Kolar district towards diabetes and diabetic retinopathy.MATERIALS AND METHODS: A cross sectional survey was conducted in rural Kolar district during May 2013.The study participants were 38 physicians and 2 general practitioners who had special training in diabetes.The data were collected by means of filling up of pre-tested specially designed questionnaires focused on awareness towards Diabetes Mellitus and Diabetic retinopathy.The assessment was done by total score as satisfactory (Diabetic retinopathy awareness index >12), moderately satisfactory (DRAI 9-11) or unsatisfactory if index <8.RESULTS: The mean of overall awareness score (±SD) for all the respondents were 10.9+1.8 (Maximum 15).In the present study, the satisfactory score (DRAI>12) was attained by only 55% (22/40) practitioners.Nearly 62.5% of physicians refer the diabetics to ophthalmologists only when they develop significant vision problems.CONCLUSION: This survey highlighted some of the lacunae in the knowledge about referral system of the general physicians and identified the need for improvement in awareness regarding the management of the patients with diabetes and diabetic retinopathy.To improve patient compliance, physician needs to educate their diabetic patients about the importance of setting an annual eye examination routinely before the development of vision loss.
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Purpose Glaucoma is an irreversible chronic disease that damages the optic nerve. Knowledge and skills related to glaucoma are extremely important for frontline physicians. This study aimed to determine the knowledge and management as well as examination and referral practices related to glaucoma among physicians at primary care centers and secondary hospitals in Riyadh, Saudi Arabia. Method This was a cross-sectional study of 126 physicians, including general practitioners as well as emergency, internal, and family physicians from three hospitals and five medical centers in Riyadh. A validated self-administered questionnaire was used for data collection. It was divided into six categories: sociodemographic data and practice setting; and glaucoma assessment-questions regarding risk factors, knowledge, examination, management, and referral practices. Results Of the 126 participants, 32.8% were family physicians. Surprisingly, the overall knowledge score for glaucoma was suboptimal (34.2%). While half of the doctors were aware of the medications used in glaucoma, 88.7% considered themselves unqualified to manage glaucoma. Although 93.7% agreed that increased ocular pressure requires urgent referral to an ophthalmologist, only 33.3% stated they were comfortable using tonometry. Conclusion The majority of physicians (65.8%) showed a poor level of knowledge regarding glaucoma, which was reflected in their referral practices (66.9%). Therefore, promoting increased glaucoma awareness along with improved examination skills and referral practice among frontline physicians is essential to prevent this avoidable cause of blindness.
Cross-sectional study
Eye examination
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Background: The eye health care program, Ministry of Health of Oman conducted a pilot survey of Omani people that visited the eye health stall. It was organized on the World Health Day on 7 th April 2005 in Muscat, Oman. The survey aimed at identifying the level of knowledge of blinding eye diseases and the satisfaction among community for the eye services at government hospitals.Materials and Methods: This was a descriptive study. 156 Omani citizens of more than 12 years of age were given a close ended questionnaire. Their self reported responses were collected. Six questions related to cataract, diabetic retinopathy, refractive error, blindness, home treatment, rehabilitation of visually impaired and perception of eye services at Ministry of Health hospitals were asked with three grades of responses to choose from. Results: The knowledge about cataract and diabetic retinopathy was found to be good in more than 70% of respondents. 35% of participants agreed for home treatment of minor eye ailments. The importance of using visual aids and the need to give special facilities for the visually impaired was positive in 85%. Two thirds of the respondents were satisfied with type of eye services. Association of knowledge and satisfaction to the gender and age group was not conclusive. Conclusions: Knowledge regarding cataract surgery and blindness due to diabetes, attitude towards use of spectacles, perceived need for visual rehabilitation and satisfaction with eye care services was positive in more than 60% of the interviewed people in this pilot study. A larger study representing Omani population is recommended.
Visual Impairment
Eye care
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Blinding
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Attendance
Eye examination
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SUMMARY OBJECTIVE: First care providers working in the Brazilian Unified Health System are often physicians from the Family Health Program. Their knowledge on ophthalmology could indicate whether there is a need for training to decrease ophthalmological demands to secondary or tertiary health levels. METHODS: A cross-sectional observational study based on an electronic questionnaire was conducted to evaluate the ophthalmological knowledge of Family Health Program physicians working at the VI Regional Health Department, Sao Paulo, Brazil. All Family Health Program physicians from this regional health department were invited, and the study included those who responded to the full questionnaire (115 physicians). The data were evaluated using descriptive analysis. RESULTS: There was no difference in the ophthalmological knowledge between sexes or in relation to undergraduate schools. Only 20% of the interviewees were specialized in Family and Community Medicine, which did not influence the number of correct answers. Only 22 (19.1%) physicians reported having enough knowledge about the main eye disorders, and 82 (71.3%) physicians considered themselves capable of treating ophthalmological emergencies. However, acute glaucoma was recognized by only 51 (44.3%) physicians, and eye perforations could only be handled by 65 (56.5%) of them. In addition, only 47 (40.9%) participants correctly answered that congenital cataracts should be operated right after diagnosis. CONCLUSIONS: Family Health Program physicians working as first care providers in the Health System in Brazil presented poor ophthalmological knowledge. Providing training on ophthalmology may improve the ophthalmological care at the primary level within SUS and reduce the case demands at other healthcare levels.
Cross-sectional study
Family health
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Integration of oral health promotion into general health care has been highly recommended by the World Health Organization. Primary-care physicians can as part of their general health care promote and contribute to improved oral health care. Our aim was to investigate primary-care physicians' knowledge of oral health, their attitudes toward delivering oral health care (OHC), and their willingness to obtain more education in this field.We conducted a cross-sectional survey of all primary-care physicians working in the public health centers of Tehran city. An anonymous self-administered questionnaire queried their knowledge in pediatric- and general medicine-related areas of dentistry, providing knowledge scores to be calculated for three domains. The physicians' attitudes toward OHC and willingness to pursue continuous education underwent evaluation with statements utilizing a 5-point Likert scale. Totally, 220 physicians took part in the survey (response rate: 92%). Chi-square test, linear and logistic regression, and t-test served for statistical analyses.The physicians' knowledge score was significantly lower in the pediatric domain than in the dental and medical domains (p < 0.001). The number of physicians answering correctly to the pediatric questions was less than 40%. Almost all physicians (95%) reported it necessary for a physician to know about OHC and admitted (78%) that physicians' general knowledge in this field is inadequate. Further, 77% of the physicians expressed a will to implement preventive oral health activities in their practice, and almost two-thirds (62%) of them showed a willingness to pursue further education about OHC. Those with higher knowledge scores had a greater willingness to deliver oral health care to their patients.Physicians' lack of knowledge of OHC and their generally positive attitudes toward it revealed a great need for planning of a continuous medical education program in primary care.
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Health Services Research
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Diabetic retinopathy (DR) has been shown to be the third most observed cause of visual loss in Saudi Arabia. In the Al-Hasa region in particular, the prevalence of DR has been shown to be 30%. Primary health centre (PHC) physicians play a central role in the early detection and prevention of DR. The aim of this study was to evaluate the knowledge, attitudes, and practices regarding DR of PHC physicians in Al-Hasa, Saudi Arabia.A cross-sectional descriptive study was conducted at PHCs in Al-Hasa, Saudi Arabia. A self-administered questionnaire was provided to every participant along with a consent form. Out of 71 centres in the region, 63 were included in this study. The questionnaire consisted of three sections and a total of 18 questions. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 21 software program (IBM Corp., Armonk, NY, USA).One hundred forty-one of 209 physicians completed the questionnaire for a response rate of 67%. The mean of overall knowledge score for all participants was 2.6 ± 1.16 points out of four points. Only 34 (24.1%) of the participants correctly referred their diabetic patients according to the guidelines of the American Academy of Ophthalmology. Additionally, only 52 (36.9%) physicians educated their patients regarding the early detection of diabetic complications.The present study concluded that there exist gaps in applying the correct guidelines. Physicians' attitudes toward patient education were overall satisfactory. Further medical symposiums and workshops are warranted to teach physicians about diabetic complications and screening schedules, including DR.
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Physicians may face unique challenges in accessing health care and managing their own health.To evaluate physicians' perceptions of their health care needs and desired services.A written survey, distributed and collected anonymously among attendees at a large primary care continuing medical education conference.The survey was given to 346 physicians and 141 (41%) responded. The majority of physicians (53%) reported having difficulty accessing health care and reverting to self-diagnosis and treatment (63%). Over 83% reported having or knowing a colleague who had a career-threatening illness and 42% had experienced concern about a colleague's ability to practise safely.Physicians as an occupational group have challenges in accessing health care, very commonly suffer career-limiting illnesses and revert to self-diagnosis and treatment. Programmes tailored to providing health care to physicians are needed.
Limiting
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The levels of knowledge, attitude and practice among primary physicians concerning both diabetic retinopathy screening and treatment of sight threatening diabetic retinopathy have been studied by different groups, such as medical students, pharmacists, Primary Health Care staff and opticians. In some studies, the levels were very high, while in others it was noted to be less than desired. This study's intent is to estimate and improve level of Knowledge (K), Attitude (A) and Practice (P) among non-ophthalmic health care providers regarding eye management of diabetes and barriers that people with diabetes face in Saudi Arabia. This cross-sectional survey targeted medical doctors (except ophthalmologists) working at private sector institutions in Riyadh. They were interviewed using closed-ended questions for knowledge (8), attitude (5), practice (5), and reasons for their current KAP status comprised of 8 questions. The level of Knowledge was assessed as good if its score was (> 50%); positive attitude (> 50%) and excellent practice (> 75%) were estimated and associated to the risk factors. Out of the 355 participants that were interviewed, the percentages of good knowledge, positive attitude and excellent practice concerning diabetic retinopathy (DR)were 193 [54.3% (95% CI 49.2–59.5)], 111 [31.3% (95% CI 26.4–36.1)], and 145 [40.8% (95% CI 35.7–46.0) participants, respectively. Gender, place of work and type of doctor were not significantly associated with the level of KAP. Salient reasons for low KAP status included a busy schedule (54.6%), less resources (75.2%), inadequate periodic training in eye care (69%), and absence of retinal evaluation training (49.6%). Improving KAP level is urgently needed. Addressing underlying causes of low KAP could enhance eye care of people with diabetes. Additionally, training for primary health care providers for early detection of DR and timely management of sight threatening diabetic retinopathy (STDR) is necessary.
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Cross-sectional study
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To assess whether family physicians and family medicine residents know what the Canadian guidelines for screening for diabetic retinopathy are, and to assess whether they believe they can perform this screening.Mailed survey with two mailed reminders.All general practitioners (N = 1038) listed in two health catchment areas, Québec and Chaudière-Appalaches administrative regions in the province of Québec, and all family medicine residents (N = 125) at Laval University Medical School. Response rate was 62% among general practitioners and 77% among residents.Knowledge of screening guidelines for diabetic retinopathy in type I and type II diabetes, including timing of the initial screening examination, risk factors, natural history, and treatment of ocular complications; and perception of ability to screen for diabetic retinopathy.Among GPs, 80% of respondents correctly chose the statement with the current guideline for first screening for diabetic retinopathy to be performed shortly after diagnosis of type II diabetes. Only 13% of respondents were familiar with the guideline for first screening 5 years after diagnosis of type I diabetes. Agreement with other correct guideline statements was also low. Overall, residents had higher scores than GPs. Most respondents were not confident in the accuracy of their eye examinations.General practitioners and family medicine residents have varying levels of knowledge about the Canadian guidelines for screening for diabetic retinopathy. These results will be useful in designing and improving educational programs for GPs in diabetic retinopathy screening.
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