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Lauryn Chris, Vanessa Desmore, Gwen Sterns, Rajeev S Ramchandran; Follow-up Care After Teleophthalmology Screening for Diabetic Retinopathy Through the Tele-I-CARE Program. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2286.
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To determine the compliance with scheduling recommendation for patients screened for diabetic retinopathy (DR) via telemedicine.
Three urban primary care clinics were designated as sites for the telemedicine DR screening program, Tele-I-CARE, in Rochester, NY. Patients diagnosed with diabetes without a documented eye exam were identified, recruited, and consented into the IRB-approved study. Visual acuity measurements (Snellen eye chart) and nonmydriatic digital retinal photographs (Carl Zeiss Nonmydriatic Visucam) were taken for each patient and electronically sent via a secure server to the retina specialist involved in the study. The images were diagnostically evaluated and follow-up care was advised within 1 month, in 1-2m, 3-4m, 6m, 8m, 9m, or 1 year. The follow-up plan was shared with the patient’s PCP and the chief of ophthalmology at the participating eye center to ensure adequate follow-up. The chief of ophthalmology and her staff used standard protocol (telephone/mail contact) to schedule patients. The date of scheduled follow-up for each patient was extracted from the eRecord system at the participating clinic (CareConnect) and compared to the recommended follow-up.
Between February and August 2013, Tele-I-CARE screened 87 patients for DR (mean age = 57.4, 42 male, 45 female). Ophthalmic disease was found in 46% (n=40) of the study population with 66% (n=31) of this associated with DR. For follow-up care, 9.1% (n=8) of the patients were advised to be seen within 1 month, 10.3% (n=9) in 1-2m, 21.8% (n=19) in 3-4m, 10.3% (n=9) in 6m, 2.3% (n=2) in 8m, 3.4% (n=3) in 9m, and 42.5% (n=37) in 1 year. Compliance with scheduling recommendation was 50% (n=4) for within 1 month, 55.5% (n=5) for 1-2m, and 100% for 3-4m, 6m, 8m, 9m, and 1 year. All 87 patients were scheduled with 90.8% (n=79) actually scheduled during the recommended time period and 9.2% (n=8) scheduled later than advised.
Scheduled follow-up complied with recommended follow-up for the majority of our patients, although there were a small number of patients who were scheduled later than advised. All of the patients with delayed follow-up were recommended to be seen within 1 month or in 1-2m, indicating a more urgent need for eye evaluation and care. This is especially concerning because deferring follow-up care in these patients may be a serious threat to their vision.
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