Recommendations for implementing rheumatic heart disease echocardiographic detection in remote Australia: A narrative review and lesson-drawing from diabetic retinopathy screening.

Paul Burgess, Benjamin Jones, Angus W Turner, Mike English, James Marangou, Jennifer Yan, Alex Kaethner, Natasha Howard, Shobhana Nagraj, Joshua R Francis

Journal: Australian journal of general practice 2025;54(1-2):75-79

PMID: 39909005

Free Full Text on Australian Family Physician View on PubMed

Abstract

BACKGROUND AND OBJECTIVES

Australia has some communities with the highest rates of rheumatic heart disease (RHD) in the world. Echocardiographic detection of RHD through active case finding has been proposed for early detection. Lessons can be learnt from the implementation of a similar program - diabetic retinopathy screening. The aim of this paper is to identify transferable lessons from the implementation of diabetic retinopathy screening that could be applied to RHD echocardiographic detection.

METHOD

This paper presents a narrative review and expert recommendations.

RESULTS

Transferable lessons from the implementation of diabetic retinopathy screening include training local staff regularly with formal certification; supplementary health promotion; program champions; general practitioner involvement; informing all staff at clinics; creating separate Medicare Benefits Schedule items for acquisition and interpretation; using echocardiography for detection and monitoring of RHD; establishing referral pathways and communication channels; local community involvement in implementation planning; and developing an adaptable program.

DISCUSSION

Implementing programs successfully and sustainably in remote communities is known to be challenging. These transferable lessons from the implementation of diabetic retinopathy screening might assist in the planning of an RHD detection program.

Address: MD, MHLM, Health Systems Collaborative, University of Oxford, Oxford, UK; Honorary Research Fellow, Menzies School of Health Research, Darwin, NT.; MBBS (Hons), MSc (Oxon), FRANZCO, Associate Professor, Centre for Ophthalmology @ Visual Sciences (incorporating the Lions Eye Institute), University of Western Australia, Perth, WA.; MBBS, FRACP, Honorary Research Fellow, Menzies School of Health Research, Darwin, NT.; MBBS, FRACP, Senior Research Fellow, Menzies School of Health Research, Darwin, NT; Paediatrician and Paediatric Infectious Diseases Physician, Department of Paediatrics, Royal Darwin Hospital, Darwin, NT.; MBBS, BMedSci, MPH, GradDipRuralGP, FRACGP-RG, FARGP, PhD, FAFPHM, GAICD, Director of Health Statistics and Informatics, Northern Territory Health, Darwin, NT.; BHlthSc, Cardiac Sonographer, Menzies School of Health Research, Darwin, NT.; BHlthSc (Hons), PhD, Associate Professor, South Australian Health and Medical Research Institute, Adelaide, SA.; MBBChir, MRCP, MD, FMedSci, Professor, Health Systems Collaborative, University of Oxford, Oxford, UK.; BSc (Hons), MBBS, MRCS, MRCGP, MPhil, DPhil, SFHEA, Associate Professor, Department of Public Health @ Primary Care, University of Cambridge, Cambridge, UK; Honorary Visiting Clinical Researcher, Health Systems Collaborative, University of Oxford, Oxford, UK.; MBBS, FRACP, Associate Professor, Menzies School of Health Research, Darwin, NT; Paediatrician and Paediatric Infectious Diseases Physician, Department of Paediatrics, Royal Darwin Hospital, Darwin, NT.

DOI: 10.31128/AJGP-05-24-7294

Link outs

Free resources

Full Text Sources:

http://www.racgp.org.au/AJGP/2025/january-february...

Medical:

https://medlineplus.gov/diabeticeyeproblems.html

MeSH Terms: Humans, Rheumatic Heart Disease, Mass Screening, Diabetic Retinopathy, Australia, Echocardiography