Abstract
Purpose :
To determine the effectiveness of telehealth (TH) services delivered by a health extender in promoting patients with diabetic retinopathy (DR) who are overdue for care to schedule and/or return for in-clinic eye examinations.
Methods :
Established patients with DR who had not been seen within the last year were identified by a retrospective review of the EMR using a reporting tool. Patients who had not returned for follow-up care were contacted by phone by a TH extender. Each patient was offered screening for acute eye problems by means of a symptom-based screening script. Those patients who raised concerns about vision-related issues were offered transfer to a physician for triage. Finally, patients were offered assistance in scheduling an in-person clinic visit.
Results :
159 patients with DR potentially overdue for care were contacted by phone. 43% of calls reached patients; 52% of calls went to patient voicemail (VM) where instructions were left for appointment-booking; 5.0% of patients were unreachable, and 2.9% of patients contacted were identified to be deceased. Of the 67 patients reached by phone, 39% reported that they had transferred/declined further care. Of the remaining 41 patients, 77% agreed to take the symptom survey, and out of those 91% went on to book a booked an appointment, including one patient who required transfer to physician triage and was brought into the clinic the next day for management of proliferative retinopathy. By contrast, the 3 patients who chose not to book an appointment after the symptom survey all reported no symptoms. A further 3 patients scheduled despite declining the symptom survey. Finally, 5 patients (12%) requested to be called back later and 3 patients (7.3%) to call back themselves. In total, 27% of patients contacted through the program ultimately booked an appointment, including 12% who were left a VM and 1 patient who was called back by a scheduler. This rate of appointment booking was more than twice that of a larger cohort of patients who were overdue for care but not engaged by the program (27% vs. 11%, X2=9.561; P=0.002).
Conclusions :
Nearly one-third of patients with DR identified as being overdue for eye care and contacted by a TH extender made follow-up appointments. This study adds to the growing body of research that TH, even when delivered by a non-provider, can help improve the rate at which patients with DR access eye care.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.