Engaging patients and clinical stakeholders to increase teleophthalmology use for diabetic eye screening in rural primary care clinics

Abstract

Purpose : Teleophthalmology is an evidence-based form of diabetic eye screening that is underutilized in U.S. primary care clinics. This technology is particularly well-suited to rural areas, which have less access and greater travel distances to obtain eye care than those in urban areas. We hypothesized that engaging patients and clinical stakeholders (i.e., primary care providers (PCPs), patient care staff, and administrators), would increase teleophthalmology use and diabetic eye screening rates in a rural U.S. primary care clinic.

Methods : Stakeholders were recruited in March 2017 from the Mile Bluff Medical Center (MBMC), a rural U.S. health system where a teleophthalmology program was established in 2015 for all primary care clinics. We recruited adult patients with diabetes who had teleophthalmology imaging or expressed interest when previously contacted in a diabetic eye screening survey. PCPs and patient care staff were recruited during a staff meeting, while administrators were selected by clinical leadership. We used the NIATx Model, a systematic healthcare process improvement framework, to guide stakeholder meetings and test strategies for increasing teleophthalmology use at one (Mauston) of 5 MBMC primary care clinics.

Results : Nine patients and 22 clinical stakeholders participated in separate meetings (n=18) from May 2017-October 2018 to identify barriers and develop strategies. Strategies tested at the Mauston clinic included patient rooming checklists, quarterly provider performance reports, and patient reminder calls. Teleophthalmology use increased 5-fold at the Mauston clinic compared to 0.4-fold at the other clinics (p < 0.0001). There was a trend towards a greater increase in diabetic eye screening rates at the Mauston clinic (15%) versus the other clinics (10%) three years after teleophthalmology was introduced (p = 0.08). Among patients adherent with diabetic eye screening in 2018, the majority had clinical dilated eye exams (89%) rather than teleophthalmology (11%).

Conclusions : We engaged stakeholders to develop an implementation program to substantially increase teleophthalmology use in a rural primary care clinic. This approach may allow for the implementation of strategies tailored to an individual clinic’s needs and resources to increase teleophthalmology use and expand access to diabetic eye screening in rural communities.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.