June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Patient and primary care provider barriers and facilitators to tele-ophthalmology use in a rural, multi-payer health system
Author Affiliations & Notes
  • Yao Liu
    Dept of Ophthalmology and Visual Science, University of Wisconsin, Madison, Madison, Wisconsin, United States
  • Rebecca Swearingen
    Dept of Ophthalmology and Visual Science, University of Wisconsin, Madison, Madison, Wisconsin, United States
  • Nora Jacobson
    University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Timothy Bjelland
    Mile Bluff Medical Center, Mauston, Wisconsin, United States
  • Maureen Smith
    University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Footnotes
    Commercial Relationships   Yao Liu, None; Rebecca Swearingen, None; Nora Jacobson, None; Timothy Bjelland, None; Maureen Smith, None
  • Footnotes
    Support  NIH Grant EY026518, Wisconsin Partnership Program, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2900. doi:
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    • Get Citation

      Yao Liu, Rebecca Swearingen, Nora Jacobson, Timothy Bjelland, Maureen Smith; Patient and primary care provider barriers and facilitators to tele-ophthalmology use in a rural, multi-payer health system. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2900.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Tele-ophthalmology for diabetic eye screening is widely underutilized in U.S multi-payer health systems. We sought to identify patient and primary care provider barriers and facilitators to tele-ophthalmology use in a rural, multi-payer health system with an active tele-ophthalmology program.

Methods : Semi-structured, individual interviews were performed using maximum variation sampling in 16 adult patients with type 2 diabetes and 8 primary care providers at the Mile Bluff Medical Center in Mauston, WI regarding tele-ophthalmology and diabetic eye screening. Sample sizes were adequate to reach thematic saturation. All interview transcripts were transcribed verbatim and analyzed using both inductive and deductive qualitative content analysis.

Results : Patients had a mean age of 67 years (range 46-86 years) and 50% were female. Reported barriers to obtaining traditional in-person diabetic eye exams included pupil dilation, cost, travel, and time. These barriers were not noted for tele-ophthalmology, which was described by those who had undergone this testing (37.5%) as “easy” and “quick.” The majority said that they had not heard previously about tele-ophthalmology, but that they would prefer it over a traditional exam mainly to avoid pupil dilation and would be comfortable using the technology if recommended by their doctor. However, some (12.5%) were concerned about needing in-person eye exams to monitor their other known eye conditions (e.g., glaucoma). Primary care providers were predominantly male (75%) and had varied training backgrounds (37.5% MD/DO, 37.5% PA, 12.5% NP, 12.5%RN). All providers thought tele-ophthalmology improved patient adherence with screening and those who had experience referring patients for tele-ophthalmology (87.5%) valued its “convenience.” Provider barriers to tele-ophthalmology included difficulty identifying when patients are due for eye screening in the electronic health record, patient eligibility criteria, notification of test results, and concerns about patient costs.

Conclusions : Tele-ophthalmology was acceptable to primary care providers and most patients in a rural, multi-payer health system. Barriers differed from those for traditional in-person diabetic eye screening. Implementation strategies to address these unique barriers are needed to maximize utilization and population-level benefits from tele-ophthalmology programs.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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