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Kerry Cotter, Zeina A Haddad, Tyson Ward, Paul Andrew Yates; The effect of immediate result feedback on compliance with ophthalmic follow-up after diabetic retinopathy screening. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1439.
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To assess the effect of immediate result delivery and appointment scheduling on patient compliance with follow-up eye care after diabetic retinopathy (DR) screening.
In 2011, a DR screening program was established at UMA, a University of Virginia (UVA) primary care clinic. A nurse captured 45° macula-centered images of diabetic patients. Images were read by a UVA ophthalmologist up to 1 week after screening. Patients who needed follow-up at UVA Eye Clinic (due to presence of DR, high A1C, ungradable photos or other pathology) were contacted within 60 days. 1455 patients were imaged over 28 months. In 2014 TigerText, a secure HIPAA-compliant messaging application was introduced. Using TigerText, UVA ophthalmologists read images on mobile phones and sent interpretation results back to UMA within 5 minutes. If needed, the nurse scheduled an ophthalmic follow-up at UVA immediately thereafter. 365 patients were imaged using this method over 8 months.
Of the 1820 patients imaged, 1154 (63%) patients were recommended to schedule follow-up with an eye physician. The follow-up completion rate was 71% before implementing instant results and 57% after. The no-show rate was 15% before and 25% after (Table 1), indicating that patient compliance surprisingly decreased with faster result delivery. On average, the time elapsed between a patient’s DR screening and follow-up was 116 days before and 24 days after implementing instant results (Table 2), indicating that less time passed between screening and follow-up after introduction of TigerText.
Providing instant results and immediate scheduling after screening does not necessarily improve the compliance rate with follow-up eye care. The higher no-show rate observed after introducing instant results can be partially attributed to the shorter timeframe (8 vs. 28 months); a longer timeframe allows patients to reschedule appointments. However, this study demonstrates that immediate follow-up scheduling does decrease the time between screening and subsequent ophthalmic referrals. Further data is needed to evaluate this over a longer time period. This study shows that implementing an online scheduling system that allows more efficient scheduling and automatic reminders may be a worthwhile investment.
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