Teleglaucoma Initiative at a Veterans Affairs Hospital
| Autor: | Ian P. Conner, Eric N. Brown, Emily L. Hughes, Julia Polat |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Telemedicine
medicine.medical_specialty medicine.diagnostic_test business.industry Electronic consultation 010102 general mathematics Teleophthalmology General Medicine Subspecialty 01 natural sciences 03 medical and health sciences 0302 clinical medicine Patient satisfaction Eye examination Family medicine Health care 030221 ophthalmology & optometry Medicine 0101 mathematics business Veterans Affairs |
| Zdroj: | Ophthalmology Glaucoma. 4:632-637 |
| ISSN: | 2589-4196 |
| Popis: | Purpose To evaluate the safety, reliability, and efficacy of telemedicine in delivering tertiary subspecialty glaucoma care (herein referred to as teleglaucoma) to the veteran patient population. Design Prospective case series. Participants Twenty patients being referred for glaucoma subspecialist opinion participated in the pilot safety study. One hundred eighteen patients participated in the secondary study of the acceptability and service efficacy of teleglaucoma. Methods In the pilot study, safety was assessed by determining interobserver and intraobserver consistency (Krippendorff’s α). This compared an in-person assessment by a glaucoma subspecialist with the remote assessment of 2 other glaucoma subspecialists (electronic health record alone reviewed). In the secondary study, teleglaucoma was implemented whereby testing and eye examination were carried out remotely by an optometrist or comprehensive ophthalmologist, and the clinical decision was made by the glaucoma subspecialist on review of the electronic health record alone. Main Outcome Measures In the pilot study, interobserver and intraobserver consistency in making a diagnosis and treatment plan (acceptable, ≥ 0.80 Krippendorff’s α). In the secondary study, patient satisfaction measured by survey, wait time for teleglaucoma opinion versus wait time for in-person opinion, and time spent on teleglaucoma consultations. Results Interobserver and intraobserver consistency showed an α of 0.86 and 0.92, respectively, for diagnosis, and 0.86 and 0.85, respectively, for treatment plan. In the secondary study, patient satisfaction was 4.55 of 5.00 (5 = maximum satisfaction; range, 3.28–4.93). Improved consultation lead time was demonstrated, with the median time for a doctor to respond to an electronic consultation being 3 days, versus 43 days for an in-person visit. Teleglaucoma also demonstrated positive benefits to the health care system by reducing the time doctors spent reviewing each patient’s case (history, examination findings, imaging results, visual fields; 19 minutes for teleglaucoma consultation vs. 31 minutes for in-person evaluation). Conclusions Decisions regarding diagnoses and treatment plans between in-person consultation and the teleglaucoma program showed high reliability. Patient satisfaction was high. Additional benefits were observed in wait time for subspecialty glaucoma opinion, efficient allocation of the doctor’s time, and fiscal benefit to the health care system. |
| Databáze: | OpenAIRE |
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