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Kristen Stebbins, Edward Chaum; Patient Follow Up After Teleretinal Imaging in a Primary Care Network. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5241.
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Teleretinal imaging has been shown to increase compliance rates for the diabetic retinal exam, but research on compliance with follow-up and treatment has been limited. The few reported studies show compliance rates near 60%. We performed a retrospective chart review in a large primary care network to determine compliance with follow-up and treatment following teleretinal screening for diabetic retinopathy (DR).
Summit Medical Group (SMG) uses the RetinaVueTM Network (RVN) teleretinal imaging program. A RVN database search identified all patients at SMG with referable pathology from June 2015 through September 2017. The SMG electronic medical record (EMR) was searched to identify patient-specific metadata including follow-up appointments, pathology identified, recommended management, and evidence of treatment received for DR.
A total of 109 patients were referred by RVN. Compliance with the follow-up appointment was 69%. Seventy-three percent of patients with newly diagnosed DR attended follow-up compared to 41% of patients with a history of DR. Of the 75 patients attending a follow-up appointment, 49 (65%) had referable DR (proliferative DR, severe non-proliferative DR, or macular edema) or other referable pathology (ex. macular degeneration). Twenty (27%) patients had mild or moderate DR and 6 (8%) patients did not have DR. Twenty-two patients were found to have clinically significant macular edema (CSME) requiring immediate treatment, with documentation of receipt of treatment in 12 (55%) of these patients.
We searched primary care clinic records and found documentation of retinal exams in 69% of patients referred by RVN, a rate similar to that of other studies. Compliance among newly diagnosed patients was significantly higher than that of patients with existing DR (73% vs. 41%).One-third of referred patients required immediate treatment for CSME. Documentation of treatment in the primary care medical record was incomplete, but indicates that more than half of the patients with CSME received treatment. Updated analysis using treatment claims data will also be presented.This study shows a significant rate of follow up for patients with newly diagnosed DR, indicating that teleretinal imaging is an effective method for providing annual diabetic retinal exams. However, additional methods to improve primary care documentation of treatment following telemedical screening may be warranted.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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