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Y. Kanagasingam, J. Yuen, M.-L. Tay-Kearney; Tele-Retinal Screenings to Reduce Long Outpatient Wait-List and Early Treatment for Diabetic Retniopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3777.
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Here we utilised telemedicine technologies to perform initial screenings before referring the patient to an ophthalmologist based in a public hospital. A virtual reading centre at the public hospital goes through all data and images electronically using a web-based telemedicine system. Only those who really need treatment and surgery were included on the outpatient wait-list and rest of the patients were sent to primary care providers to manage (or follow-up screening). This system will help reduce outpatient ophthalmology wait-list, provide timely treatment and reduce health care cost to the public health system.
In phase one of the study we have screened all those who are already on the outpatient wait-list at the Royal Perth Hospital. The imaging and data collection are done by a trained nurse. All data are uploaded to a secure web-based system for reading by an ophthalmologist. The reading outcomes are then sent to the referring doctor and the patient. We are seeing 10-20 patients per week. A questionnaire is prepared to obtain cost benefit data. We received 100% feedback (seen 300 patients so far).
The results indicate that 70% of the patients seen do not need to be seen by an ophthalmologist. They were asked to consult their primary care providers for follow-up screenings. The rest of the patients were put on the wait-list based on urgency. One of the patients had sight threatening condition and has been waiting for more than a month on the wait-list. The average waiting time for an appointment at a public hospital is 5.5 months. The results were encouraging and showed huge cost savings ($131/patient for conventional consultation to $47 for proposed consultation - 64% less) to health system. The waiting time also went done from 5.5 months to 1.1 month.
More efficient eye care delivery is possible using such simple electronic referral system and screening by trained healthcare professionals. The digital screening technique has been rolled out to other public hospitals in Western Australia.
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