A primary care-based telemedicine screening program for diabetic retinopathy found that while 51.8% of screened patients warranted an ophthalmology referral, only 9.5% successfully completed an eye exam.
Observational (n=689)
No
Does a primary care-based telemedicine screening program for diabetic retinopathy improve access and follow-up to appropriate retinal care?
While primary care-based telemedicine screening for diabetic retinopathy identifies many patients needing referral, significant communication and system gaps prevent most from receiving timely specialist follow-up.
Abstract Background Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment. Methods This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated. Results Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis. Conclusions Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted screenings actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.
Benjamin et al. (Mon,) conducted a observational in Diabetic Retinopathy (n=689). Primary care-based telemedicine retinal screening was evaluated on Completion of ophthalmology referral appointment among referral-warranted patients. A primary care-based telemedicine screening program for diabetic retinopathy found that while 51.8% of screened patients warranted an ophthalmology referral, only 9.5% successfully completed an eye exam.