Abstract
Purpose:
To determine the compliance with scheduling recommendation for patients screened for diabetic retinopathy (DR) via telemedicine.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 499 diabetic retinopathy •
550 imaging/image analysis: clinical