Interprofessional communication for diabetic eye care critical: What you should know

Even with a 25-times greater risk of going blind, some people with diabetes still don’t receive annual eye examinations—a troubling statistic that a new, interprofessional communication resource developed with eye care providers’ input aims to address.

In collaboration with the American Diabetes Association® (ADA), the AOA and other eye health care organizations developed the "Eye Care Interprofessional Communication Protocol," a digital resource outlining how eye care professionals (ECPs) and other health care professionals can efficiently and routinely exchange information to increase patient co-management. The communication protocol is available online for download and review after completing a form with the ADA.

Charles Fitzpatrick, O.D., AOA representative to the ADA workgroup, emphasizes that primary care doctors of optometry are key members of patients’ diabetic care team, and this protocol reinforces that role.

“We can assert our role with the adoption of a consistent evidence-based care sequence, which always involves the communication of the results of the examination to the care manager and primary care physician of a patient,” Dr. Fitzpatrick says.

That communication is a crucial piece of the puzzle in improving these patients’ eye health outcomes. Such is the case, the Eye Care Interprofessional Communication Protocol addresses the root of provider communications by outlining plans for exchanging information.

Specifically, the protocol includes a pair of scenarios and communication charts with narrative explanations detailing the recommended processes for health care communications regarding both individuals with known diabetes, as well as those with suspected diabetes or prediabetes. The charts identify the need for two-way communication and shared decision-making among diabetes care professionals, ECPs and patients, in addition to the communication relationships involving specialist referrals.

In working alongside other leading eye care organizations, such as the American Academy of Ophthalmology, National Eye Institute and American Society of Retina Specialists, the AOA helped identify real-world barriers to communication among diabetes care team members and emphasize how patients with diabetes are best served when their doctors work together.

“The ADA communication protocol encourages the care manager and primary care physician of the patient to be proactive in the order of a dilated fundus examination to identify diabetic retinopathy at its earliest and most treatable stage,” Dr. Fitzpatrick says. “Those same persons expect to receive a report and acknowledgement that appropriate care has been delivered and that a patient with an actionable complication of diabetes has been placed in the hands of the appropriate specialist.”

He adds: “While technology-based solutions exist, which may identify diabetic retinopathy, most primary care physicians would prefer to interact with a fellow physician who is familiar with the patient they share in the community.”

Robert Gabbay, M.D., Ph.D., the ADA’s chief scientific and medical officer, underscores how patients benefit the most from efficient, clear communication among the health care team, ultimately helping mitigate the effects of diabetes-related eye diseases and protecting vision.

“As we continue to tackle the needs of health care professionals and people with diabetes, we are excited to release this communication tool and continue the fight for improving outcomes for people with diabetes through better eye care,” Dr. Gabbay says in a news release.

The protocols stem from the ADA’s ongoing commitment to increase awareness about the connection between diabetes and eye health, the Focus on Diabetes® initiative, in partnership with visionary partners VSP Vision and Regeneron.

Optometry’s critical role on diabetes care teams

Although people with diabetes are at a much greater risk of developing vision loss and eye diseases, per the Centers for Disease Control and Prevention (CDC) as many as 60% of patients do not receive an annual eye exam. This, despite the fact, that more than 90% of vision loss caused by diabetes can be avoided with early detection and treatment.

In fact, doctors of optometry may be among the first primary health care providers to detect diabetes at all. In 2017, more than 300,000 patients first learned of their type 2 diabetes diagnoses through a comprehensive eye exam. That’s because doctors of optometry are engrained in the diabetic care and management team, serving as primary eye care providers and diabetes educators, or even moving toward point-of-care testing for better detection and diabetic management.

Comprehensive, person-centered diabetes care and education demands a “team approach;” notes the AOA Health Policy Institute (HPI). That approach is assisted through core clinical competencies in communication, counseling and education, which must be continually honed to today’s changing health care environment.

“The specialties can teach one another about the work they do in caring for the person with diabetes and can work to develop joint resources and education around diabetes self-management and the importance of regular eye care,” states the AOA HPI paper, Diabetes Clinical Management, Education, Prevention and Support Bilaterally Integrated through Optometry and Diabetes Care and Education Specialists. “There is great value in this type of information-sharing.

The paper concludes: “Doctors of optometry can play a key role in referring persons with diabetes to [Diabetes Self-Management Education and Support] or recommending that their patients seek a referral for DSMES services as they sit on the front lines of care and will likely see individuals with both diagnosed and undiagnosed vision changes. This may indicate the presence of other related chronic health conditions, whereby a [Certified Diabetes Care and Education Specialist] can reinforce with their patients the important role of doctors of optometry in fulfilling the needed screenings, examinations and treatments so that eye disease and related health conditions can be prevented or caught early.”