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Vinadé Chagas ME, Cristina Jacovas V, de Campos Moreira T, Rodrigues Moleda Constant HM, Fernanda Rohden S, Stiehl Alves S, Santini F, Dall'Agnol S, König Klever E, Cezar Cabral F, da Silva Terres M. Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis. Telemed J E Health 2024; 30:1522-1538. [PMID: 38436274 DOI: 10.1089/tmj.2023.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.
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Affiliation(s)
- Maria Eulália Vinadé Chagas
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Suelen Stiehl Alves
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Santini
- Universidade do Vale do Rio dos Sinos (Unisinos), Business School, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sara Dall'Agnol
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Emanuele König Klever
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Mellina da Silva Terres
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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2
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Nikita E, Gazzard G, Sim DA, Fasolo S, Kortum K, Jayaram H. Expansion of patient eligibility for virtual glaucoma clinics: a long-term strategy to increase the capacity of high-quality glaucoma care. Br J Ophthalmol 2023; 107:43-48. [PMID: 34321213 DOI: 10.1136/bjophthalmol-2020-318556] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/01/2021] [Indexed: 01/18/2023]
Abstract
AIMS The virtual glaucoma clinic (VGC) is a well-established diagnostic pathway for delivery of glaucoma care. Current UK national guidance recommends VGCs for patients with ocular hypertension, glaucoma suspects or early glaucoma. This study evaluates whether expanded eligibility criteria, including other glaucoma phenotypes and disease stages, can deliver safe and effective care with a positive patient experience. METHODS Records of over 8000 patients were reviewed in order to determine suitability for VGC attendance using expanded eligibility criteria. Patients with three prior consecutive visits within the glaucoma service were included. Follow-up interval, clinic type, visual acuity (VA), intraocular pressure (IOP) and visual field performance were recorded. Patient satisfaction was recorded for a sample of 118 patients. RESULTS 2017 patients over 31 months were included. Two-thirds of eyes had ocular comorbidities, a fifth of eyes had undergone prior cataract surgery and 10% of eyes had undergone a prior laser treatment for glaucoma. After three visits, 32% of patients remained in the VGC, 42% were seen in face-to-face clinics and 25% were discharged. There were no clinically significant changes in VA, IOP and visual field performance during follow-up. 72% of patients expressed a preference to continue their care within VGCs. CONCLUSIONS This study demonstrates that VGCs with expanded patient eligibility criteria can deliver high-quality glaucoma care that is safe, effective and with high levels of patient satisfaction. This approach provides a long-term solution to adapt delivery of glaucoma care to our expanding and ageing population.
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Affiliation(s)
- Eleni Nikita
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sandro Fasolo
- Performance & Information, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Karsten Kortum
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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3
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Stewart C, Coffey-Sandoval J, Souverein EA, Ho TC, Lee TC, Nallasamy S. Patient and Provider Experience in Real-Time Telemedicine Consultations for Pediatric Ophthalmology. Clin Ophthalmol 2022; 16:2943-2953. [PMID: 36071727 PMCID: PMC9444028 DOI: 10.2147/opth.s374811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Telemedicine adoption hinges on positive experiences for patients and providers. We report participants’ experience from our prospective study. Patients and Methods Ophthalmic examinations for children 0–17 years of age were conducted by an optometrist using digital exam instruments and streamed to an ophthalmologist. The ophthalmologist, optometrist, parent, and patient (≥10 years) completed surveys capturing patient and provider experience outcomes. Results Three hundred forty-eight examinations were conducted with 210 patients in a hospital-based pediatric ophthalmology clinic. About 99% of parents were comfortable with exam quality, and 97% indicated they would have another telemedicine examination. Fifty-four of 55 consented for surgery during the initial telemedicine examination. Thirty-seven percent of families traveled ≥2 hours round-trip to their appointment; 1/3 of parents and patients missed a full day of work/school. Video glasses were by far the most useful instrument, while technical proficiency was most challenging with the digital indirect ophthalmoscope. Problem-focused examinations took 33 minutes of the ophthalmologist’s time on average. Equipment challenges caused delays in 40/348 (11.5%) of visits, with the majority lasting 5–10 minutes. In a few cases, a backup device was used. Despite seeing significantly fewer patients on telemedicine days, the ophthalmologist’s surgical volume increased 25%. Conclusion All participants were satisfied with telemedicine visits despite longer durations and learning curve. Results indicate an opportunity for telemedicine in community settings to improve access to specialized care. Telemedicine enabled the optometrist to manage or co-manage more complex patients with a pipeline to the ophthalmologist for surgical cases. In the right setting, collaborative telemedicine consultations may be beneficial to one’s practice.
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Affiliation(s)
- Carly Stewart
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Erik A Souverein
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Tiffany C Ho
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Thomas C Lee
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Sudha Nallasamy
- The Vision Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- Correspondence: Sudha Nallasamy, The Vision Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS #88, Los Angeles, CA, 90027, USA, Tel +1 323 361 4510, Fax +1 323 361 7993, Email
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Snider MJE, Maa AY, Guyton AC, Park H, Hunt KJ, Pope C. Stakeholder perceptions affecting the implementation of teleophthalmology. BMC Health Serv Res 2022; 22:1086. [PMID: 36008809 PMCID: PMC9403222 DOI: 10.1186/s12913-022-08386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Teleophthalmology has become the subject of heightened interest and scrutiny in the wake of the SARS-CoV-2 global pandemic. A streamlined implementation framework becomes increasingly important as demand grows. This study identified obstacles to teleophthalmology implementation through summative content analysis of key stakeholders' perceptions. DESIGN Summative content analysis of transcribed interviews with key stakeholders (including patients, technicians, ophthalmic readers, staff, nurses, and administrators at two teleophthalmology clinic sites). METHODS Keyword Were counted and compared to examine underlying meaning. Two analysts coded text independently using MAXQDA for summative qualitative content analysis to derive themes and hierarchical relationships as a basis for future refinement of TECS implementation. xMind ZEN was used to map conceptual relationships and overarching themes that emerged to identify perceived facilitators and barriers to implementation RESULTS: Analysis revealed two themes common to perceptions: (1) benefits of care, and (2) ease of implementation. Perceived benefits included efficiency, accessibility, and earlier intervention in disease course. The quality and quantity of training was heavily weighted in its influence on stakeholders' commitment to and confidence in the program, as were transparent organizational structure, clear bidirectional communication, and the availability of support staff. CONCLUSION Using a determinant framework of implementation science, this report highlighted potential hindrances to teleophthalmology implementation and offered solutions in order to increase access to screening, improve the quality of care provided, and facilitate sustainability of the innovation.
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Affiliation(s)
- Molly J E Snider
- Cleveland Clinic Cole Eye Institute, 2022 E 105th St I Bldg, Cleveland, OH, 44106, USA. .,Emory University, Atlanta, USA.
| | - April Y Maa
- Emory University, Atlanta, USA. .,VISN 7, Regional Telehealth Services, Atlanta Veterans Affairs Medical Center, Atlanta, USA. .,Atlanta VAMC CVNR, 1670 Clairmont Road, MC150R, Decatur, GA, 30033, USA.
| | | | | | - Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Charlene Pope
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC; and, Department of Pediatrics, Medical University of South Carolina, Charleston, USA
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5
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Blais N, Tousignant B, Hanssens JM. Tele-refraction in tele-eye care settings. Clin Exp Optom 2022; 105:573-581. [PMID: 35094668 DOI: 10.1080/08164622.2021.2009736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Refraction is an important part of a comprehensive eye examination, and when performed remotely through information and communication technology or when its results are transmitted for remote analysis, this procedure is called tele-refraction. Uncorrected refractive errors are the main reason for consultation in primary eye care, and an increasing number of eye care providers offer tele-refraction services in response to the global demand. Even so, very little literature exists on how the correction of refractive errors can be managed through tele-eye care. The objectives of this review are to examine the integration of tele-refraction in different eye care models and to report the existing findings regarding patient satisfaction towards tele-refraction and the efficacy of tele-refraction. Searches were undertaken on Medline, Embase, EBM Reviews, CINAHL and Web of Science to identify relevant articles. All original studies describing a clinical tele-refraction service and its outcomes were included. Out of 1322 articles, 15 were retained for analysis and have shown that tele-refraction has been provided for general eye care (n = 10; 67%), refractive-only examinations (n = 3; 20%) or disease-specific screening (n = 2; 13%). Ten (67%) had a hybrid telemedicine modality. Given the small number of included studies and the lack of outcomes comparing refractive errors between face-to-face and remote refraction, it is concluded that the current scientific literature does not reflect the increasing availability of tele-refraction in clinical practice. More studies on remote refraction should be conducted to better understand its efficacy, cost-effectiveness and impacts on patient satisfaction and management.
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Affiliation(s)
- Nicolas Blais
- School of Optometry, Universite de Montreal, Montreal, Canada
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Impact of Implementing Teleophthalmology Referral Guidelines Using the eyeSmart EMR App in 63,703 Patients from India. Int J Telemed Appl 2022; 2022:8523131. [PMID: 35126512 PMCID: PMC8813305 DOI: 10.1155/2022/8523131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/06/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. To describe the clinical indications and the impact of implementation of specific teleophthalmology referral guidelines in a large rural village vision centre network in India. Methods. This cross-sectional vision centre-based study included 1,016,284 patients presenting between January 2017 and March 2020. Patients who were referred for a teleophthalmology opinion were included as cases. The data were collected using the eyeSmart EMR app on a smart tablet. A training intervention was done to reinforce the implementation of targeted teleophthalmology referral guidelines. Results. Overall, 63,703 (6.3%) patients were referred for a teleophthalmology opinion and were included for analysis. The median age was 41 (IQR: 26-59) years, and adults (88.4%) were commonly referred for a consult. The two most common age groups were between 31-40 years (17.4%) and 21-30 years (16.3%), and the majority of patients were male (59.1%). The most common clinical indication was cornea and anterior segment disorders (71.05%). The most common queries for teleophthalmology referral before versus after the reinforcement of implementation of guidelines were red eye (33.4% vs. 45.6%) followed by cataract (21.2% vs. 8.1%). There was an increase in the red eye (<0.001) and a decrease in cataract (<0.001) which was statistically significant. The proportion of patients for whom a teleophthalmology consult could have been requested but not sent was minimal (2.3%). Conclusion. Implementation of targeted teleophthalmology referral guidelines enables an effective triage to seek opinion for more pertinent ocular diseases that require care. Adult male patients with cornea and anterior segment disorders are most commonly referred for a teleophthalmology opinion.
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7
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Chen DA, Tran AQ, Dinkin MJ, Lelli GJ. Ophthalmic Virtual Visit Utilization and Patient Satisfaction During the COVID-19 Pandemic. Telemed J E Health 2021; 28:798-805. [PMID: 34609934 DOI: 10.1089/tmj.2021.0392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Due to the COVID-19 pandemic, there was a surge in synchronous ophthalmic telehealth visits. The purpose of this study is to analyze the utilization and patient satisfaction of synchronous ophthalmic video visits over the course of the COVID-19 pandemic. Methods: In this retrospective, single-center cross-sectional study, 1,756 patients seen through synchronous video visits between March 1, 2020, and March 31, 2021, were identified using billing codes. E-mails containing a validated, 11-item, telehealth satisfaction scale were sent to patients who had at least one video visit within the study period. Questions were scored on a 1-4 scale, corresponding to poor, fair, good, and excellent. Main outcome measures included patient satisfaction scores, frequency of repeat video visits, and primary visit diagnoses. Results: The top 3 subspecialties by virtual visit volume were oculoplastic surgery (999 visits, 42.9%), neuro-ophthalmology (331 visits, 17.0%), and cornea (254 visits, 14.2%). The top 3 diagnoses seen were chalazion/hordeolum, dry eye, and meibomian gland dysfunction. The overall survey response rate was 14.3% (252 participants). The mean patient satisfaction score was 3.67 ± 0.63, with no significant difference in scores between specialties. A total of 380 (21%) patients had repeat virtual visits. Mean survey response scores were significantly higher for patients with repeat visits than those without (3.82 ± 0.42 vs. 3.62 ± 0.68, p = 0.03). Patients undergoing oculoplastic services were more likely to have repeat visits (odds ratio 2.58, 95% confidence interval 2.18-3.06, p < 0.001). Multivariate regression analysis found that provider thoroughness/skillfulness was the most predictive feature of the patient returning to a telehealth encounter (p = 0.01). Conclusions: Our study suggests that synchronous videoconferencing for ophthalmology is a highly satisfactory delivery method and will likely find continued success in select subspecialties as the pandemic fades.
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Affiliation(s)
- Darren A Chen
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | - Ann Q Tran
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
| | - Marc J Dinkin
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA.,Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Gary J Lelli
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York, USA
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8
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Karthik N, Shields RA, Brown MM, Aoun M, Wolfe JD, Drenser KA, Capone A, Williams GA. Interest in Telehealth Among Patients With Chronic Retinal Conditions. JOURNAL OF VITREORETINAL DISEASES 2021; 5:382-388. [PMID: 37008704 PMCID: PMC9976128 DOI: 10.1177/24741264211003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work investigated interest in telehealth services for patients with chronic retinal conditions. Methods: A single-center, multi-office study was conducted of patients with chronic retinal conditions who were seen by 1 of 4 physicians during June 2020. Patients whose next appointment was 6 months or later were telephoned. Patients completed a phone interest survey about their interest in a hybrid telehealth evaluation instead of a complete office evaluation with their provider. Results: Of 2136 patients reviewed, 453 met eligibility to participate in the survey. A total of 159 patients (35.1%) participated, of whom 91 (57.2%) indicated an interest in telehealth at their next follow-up visit. Of the 68 (42.8%) patients without a current interest in telehealth, 13 (19.1%) expressed interest in pursuing telehealth in the future. Age ( P = .19), sex ( P = .22), race ( P = .79), office location ( P = .19), number of prior visits ( P = .58), and median household income by patient’s zip code ( P = .14) were not predictors of telehealth interest. Among diagnoses, dry age-related macular degeneration was associated ( P = .04) with increased interest in telehealth. An increased number of ocular diagnoses were also found to predict a decreased ( P = .04) interest in telehealth. multivariable analysis revealed healthcare provider as the only significant predictor for interest in telehealth ( P = .03). Conclusions: Most patients with chronic retinal conditions may be interested in incorporating telehealth into routine care. Considerations should be made to evaluate interest in telehealth to guide patients to clinical experiences that best suit their needs.
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Affiliation(s)
- Naveen Karthik
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Meghan M. Brown
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Mariam Aoun
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Jeremy D. Wolfe
- Associated Retinal Consultants, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kimberly A. Drenser
- Associated Retinal Consultants, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Antonio Capone
- Associated Retinal Consultants, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - George A. Williams
- Associated Retinal Consultants, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Khan ZA, Zahoor A, Afzal I, Butt U, Siddiqui AM, Khan Z, Shah IA, Shah JA. Evaluation of Patient Perception and Satisfaction Toward the Use of Telemedicine During Pandemic of Novel Coronavirus in Pakistan. Telemed J E Health 2021; 27:1174-1179. [PMID: 33449871 DOI: 10.1089/tmj.2020.0343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The trend of telemedicine is exponentially increasing worldwide due to the coronavirus disease (COVID-19) pandemic. However, patient satisfaction is always a concern regarding the use of telemedicine. Introduction: The aim of this study is to evaluate the perception and satisfaction level of patients toward the use of telemedicine during the pandemic of COVID-19 among Pakistani population. Materials and Methods: The survey questionnaires were distributed to 251 patients who received telemedicine consultation in any of three specializations: orthopedic, ophthalmology, and general medicine. The questionnaire contains 15 questions that covered four categories of patient satisfaction: interpersonal communication, caring, care delivery, and proficiency. Descriptive and analytical statistics were obtained by analyzing data using SPSS software version 20. Results: A total of 251 patients responded to the telemedicine questionnaire. Overall, 61.35% patients reported that they did not need any support for using technology during consultation and 96.41% of the patient population reported that telemedicine saved their travel time. It was found that gender, education, and age were significantly associated with the ease in technology with the p-value 0.012, 0.004 and <0.001, respectively, whereas the use of telemedicine again in future is found to be significantly associated with only education and age p-value <0.001. The statistically significant difference was found in three specialized consultation regarding the overall satisfaction, χ2 = 5.83, p-value = 0.05, with a mean rank in orthopedic is 133.6, 134.4 in ophthalmology, and 113.6 in internal medicine. Conclusion: Telemedicine is convenient and satisfactory way to provide health care services during pandemic. Although a considerable number of participants reported good response for telemedicine, there is a need of establishing local telemedicine guidelines, training of consultants and advancement in technology.
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Affiliation(s)
| | | | - Irum Afzal
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Umer Butt
- AO Hospital, Karachi, Pakistan.,Circle Bath Hospital, Bath, United Kingdom
| | - Athar M Siddiqui
- AO Hospital, Karachi, Pakistan.,Guys and St Thomas's NHS Trust, London, United Kingdom
| | - Zeeshan Khan
- AO Hospital, Karachi, Pakistan.,Hayatabad Medical Complex, Peshawar, Pakistan
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10
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Conway MP, Forristal MT, Treacy MP, Duignan ES. Investigating the Role of Optometrists in Teleophthalmology and the Implications of Increasing Access to Advanced Imaging Techniques and Digital Referral: A Systematic Search and Review. Telemed J E Health 2020; 27:974-981. [PMID: 33275866 DOI: 10.1089/tmj.2020.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The objective of this systematic search and review was to investigate the role of optometrists in teleophthalmology and digital referral. We examine the implications of the optometric communities' increasing access to advanced imaging, such as optical coherence tomography (OCT), in ophthalmic telemedicine schemes. Methods: A systematic search was conducted, using PubMed and Embase, in April of 2019. Eight hundred eight (n = 808) texts were retrieved and 99 articles were deemed eligible for full-text review. Twenty-six (n = 26) studies were included in the qualitative synthesis. All studies involved optometrists as principal service providers. Results: Findings demonstrate that optometrist-facilitated teleophthalmology results in consistent reductions in hospital referrals and waiting times, as well as high patient satisfaction. Optometrists are identified as crucial to the success of many projects and their access to advanced imaging technology is observed to position optometry practices as the most convenient location to establish a teleophthalmology program. OCT imaging demonstrated the potential to increase diagnostic accuracy and is increasingly prevalent in optometry practice. The importance of additional training for optometrists participating in teleophthalmology schemes is highlighted, as is the need for appropriate remuneration for those involved. Conclusion: The role of community-based ophthalmic care in reducing demands on hospital eye services (HES) is highlighted by our results, demonstrating that optometrist-facilitated teleophthalmology can dramatically reduce referrals and streamline care. In addition, the increasing prevalence of OCT in optometric practice represents an underutilized resource for HES.
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11
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Tahhan N, Ford BK, Angell B, Liew G, Nazarian J, Maberly G, Mitchell P, White AJR, Keay L. Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia. BMJ Open 2020; 10:e036842. [PMID: 33020087 PMCID: PMC7537459 DOI: 10.1136/bmjopen-2020-036842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care. DESIGN Retrospective audit of medical and financial records to compare two models of care. SETTING A large, urban tertiary Australian publicly funded hospital. INTERVENTION C-EYE-C is a collaborative care model, involving community-based optometrist assessment and 'virtual review' by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017. PARTICIPANTS New low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit. PRIMARY AND SECONDARY OUTCOMES Historical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic. RESULTS There were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47-0.81) and management (κ=0.66, CI 0.45-0.87). CONCLUSION This Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.
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Affiliation(s)
- Nina Tahhan
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Belinda Kate Ford
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Global Health, University College London, London, United Kingdom
| | - Gerald Liew
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | | | - Glen Maberly
- Department of Integrated and Community Health, Blacktown Hospital, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Mitchell
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J R White
- Department of Ophthalmology, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
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Sharma M, Jain N, Ranganathan S, Sharma N, Honavar SG, Sharma N, Sachdev MS. Tele-ophthalmology: Need of the hour. Indian J Ophthalmol 2020; 68:1328-1338. [PMID: 32587158 PMCID: PMC7574128 DOI: 10.4103/ijo.ijo_1784_20] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023] Open
Abstract
Telemedicine and tele-ophthalmology have been in existence since many years, but have recently gained more importance in the present scenario of pandemic COVID-19. The attitude and perception of the doctors and patients has been changing gradually. Telemedicine has many advantages including providing care in inaccesible areas.In the present scenario, tele-ophthalmology gives an oppurtunity to patient for seeking consultation while also protecting against the contagion. There are many barriers faced by the patients and doctors that have restricted use of this technology in the past. However, with a systematic approach to designing the best suited technology, these barriers can be overcome and user friendly platforms can be created. Furthermore, the demand and use of teleconsulation had increased presently in this area of pandemic. Recent survey conducted by the All India Ophthalmological Society also reveals that many ophthalmologists who have not used tele-ophthalmology in the past are more keen to use it presently. In this article, we have reviewed telemedicine and tele-ophthalmology literature on Google and PubMed to get a holistic idea towards teleconsultation, its advantages, increased importance and prefrence during COVID-19 pandemic and various barriers faced so that the known challenges can be understood, which can pave way for better understanding and future incorporation into practice.
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Affiliation(s)
- Mohita Sharma
- Chairperson and Chief Ophthalmologist, Department of Ophthalmology, Tirupati Eye Centre, Noida, Uttar Pradesh, India
| | - Neha Jain
- Cornea, Cataract and Refractive Surgeon, Department of Ophthalmology, Tirupati Eye Centre, Noida, Uttar Pradesh, India
| | | | - Naman Sharma
- Medical Superintendent, Manas Hospital, Noida, Uttar Pradesh, India
| | - Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, India
| | - Namrata Sharma
- Dr. RP Centre for Ophthalmic Sciences, All India Institute of Ophthalmic Sciences, New Delhi, India
| | - Mahipal S Sachdev
- Chairman and Medical Director, Centre for Sight Group of Eye Hospitals, President, All India Ophthalmological Society, India
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Incorporating Video Visits into Ophthalmology Practice: A Retrospective Analysis and Patient Survey to Assess Initial Experiences and Patient Acceptability at an Academic Eye Center. Ophthalmol Ther 2020; 9:549-562. [PMID: 32535837 PMCID: PMC7293175 DOI: 10.1007/s40123-020-00269-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has led to rapid adoption of teleophthalmology to deliver eyecare remotely. The purpose of our study was to assess the implementation and patient acceptability of video consultation for outpatient ophthalmic care at our institution. METHODS We conducted a retrospective, cross-sectional analysis and patient survey of adult patients who completed a virtual video visit at our institution from 18 March 18 through to 27 April 2020. All video visit encounters were assessed for patient characteristics, diagnoses, management, and follow-up outcomes. Patients were surveyed for their feedback on acceptability and utility of their virtual video consultation. RESULTS A total of 219 patients (mean age 55 years; range 21-89 years) completed 231 video visit encounters at our department over a 6-week period, of whom 118 were women (54%). About half of these encounters were acute visits (102 visits, 47%). The most common diagnosis of these visits was postoperative state (20 visits, 9% of the total), followed by conjunctivitis (16 visits, 7%), and keratitis (14 visits, 6%). The most common management decisions were medication prescription (102 visits, 46%) or reassurance (86 visits, 39%), while 17 video visit patients (8%) were escalated to an urgent, in-person evaluation. Ninety-two patients completed a follow-up survey (42% response rate), of whom 45 (49%) indicated that they might have delayed seeking care during this pandemic in the absence of a virtual video option. Seventy-two (78%) reported that they would consider participating in a video visit as an alternative to an office-based encounter in the future, and the overall video visit experience was rated highly, with a weighted mean Likert scale rating of 4.3 out of 5 (Cronbach's α = 0.88). CONCLUSION Virtual video visits may be used to manage a range of ophthalmic complaints. Patients participating in this survey found such video visits acceptable and timesaving, and the majority would consider using video consultations for future eyecare encounters.
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Al-Fawaz K, Al Rubaie K, Yasir Z, Khandekar R. Perception Among Diabetic Patients of Telescreening for Diabetic Retinopathy. Telemed J E Health 2020; 26:1455-1460. [PMID: 32522110 DOI: 10.1089/tmj.2019.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the satisfaction of diabetic patients and its determinants of telescreening for diabetic retinopathy (DR) in Saudi Arabia. Methods: This cross-sectional survey was conducted in December 2018 in a diabetes center of Riyadh, Saudi Arabia. Ten questions were asked by the interviewer. A 5-point Likert scale was used to grade patient responses for each question. Rasch analysis was conducted to evaluate the response of the participants. The main outcome variable was the sum of the Logit values of the responses. The Rasch score was also compared among subgroups. Results: Two hundred (n = 200) diabetic patients were interviewed. The median Rasch score of client-perceived benefit of DR telescreening was +14.6 (25% quartile +3.09, minimum; -23.2, maximum; +35.7). A positive attitude of patients regarding DR telescreening was recorded in 159 (79.5%) participants. The perception of telescreening was better in younger diabetic patients than in older diabetic patients (Friedman p < 0.001). The perception was similar in both genders (Mann-Whitney p = 0.3). Diabetic patients from Riyadh and the southern region of Saudi Arabia had significantly more positive perception than those from north and eastern regions (Freedman p < 0.001). Conclusion: Diabetic patients have positive attitude toward tele-DR screening. Their cooperation is likely to be high if large scale tele-DR screening is implemented in the Kingdom.
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Affiliation(s)
- Khalid Al-Fawaz
- Administration Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khalid Al Rubaie
- Retina Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Zia Yasir
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Sink J, Blatt S, Yoo D, Henry M, Yang SD, Vasaiwala R, Ghadiali L, Adams W, Bouchard CS. A novel telemedicine technique for evaluation of ocular exam findings via smartphone images. J Telemed Telecare 2020; 28:197-202. [PMID: 32506998 DOI: 10.1177/1357633x20926819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we compared the assessment of remote smartphone photographs to in-office exams in the diagnosis of two groups of external eye diseases, red-eye pathology and post-operative eyelid surgery complications. Participants were examined and received an in-office diagnosis by either a corneal or oculoplastic specialist. After viewing an educational video on smartphone photography, the patient's companion then took a series of standardized photographs. Two additional corresponding specialists then made a separate diagnosis via the interpretation of only smartphone images and the patient's history. 'Remote' and in-office diagnoses were compared using a kappa test for agreement. The remote and in-office diagnoses were in agreement for 27 of 28 eyes, representing a chance-corrected Kappa agreement rate of 93% (95% confidence interval: 79-99%). Among the 16 red eyes, the diagnoses were in agreement for 15 of 16 red eyes, representing a chance-corrected Kappa agreement rate of 92% (95% confidence interval: 77-99%). Among the 12 eyes with post-operative eyelid surgery complications, the diagnoses were in perfect agreement. Our results suggest that the diagnosis of 1) red-eye pathology and 2) post-operative eyelid surgery complications based on smartphone images may be comparable to in-office exams.
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Affiliation(s)
- Joshua Sink
- Stritch School of Medicine, Loyola University Chicago, Maywood, USA
| | | | - David Yoo
- Edward Hines Jr. VA Hospital, Hines, USA.,Department of Ophthalmology, Loyola University Chicago, Maywood, USA
| | - Michael Henry
- Department of Ophthalmology, Loyola University Chicago, Maywood, USA
| | - S Daniel Yang
- Stritch School of Medicine, Loyola University Chicago, Maywood, USA
| | - Roshni Vasaiwala
- Department of Ophthalmology, Loyola University Chicago, Maywood, USA
| | - Larissa Ghadiali
- Edward Hines Jr. VA Hospital, Hines, USA.,Department of Ophthalmology, Loyola University Chicago, Maywood, USA
| | - William Adams
- Department of Public Health Sciences, Loyola University Chicago, Maywood, USA
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Alhumud A, Al Adel F, Alwazae M, Althaqib G, Almutairi A. Patient Satisfaction Toward a Tele-Retinal Screening Program in Endocrinology Clinics at a Tertiary Hospital in Riyadh, Saudi Arabia. Cureus 2020; 12:e7986. [PMID: 32523842 PMCID: PMC7273468 DOI: 10.7759/cureus.7986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Tele-retinal screening programs use a nonmydriatic camera for retinal imaging. These images are reviewed by ophthalmologists, for interpretation and planning of appropriate treatment and follow up. Patient satisfaction is a critical tool to assess the quality of healthcare delivery and to reframe the current screening programs. The aim of this study is to measure satisfaction toward a tele-retinal screening program among diabetics attending endocrinology clinics at a tertiary hospital in Riyadh. Methods: This is a cross-sectional study that included a total of 163 patients recruited while attending tele-retinal screening at King Abdul-Aziz University Hospital in Riyadh, during the period between May and August 2019. A self-administrated Patient Satisfaction Questionnaire PSQ18 was used which included demographic data, diabetes history, and seven domains of satisfaction that were measured. Results: Some 54% of the respondents were male. The average age was 44.8 years. Some 49.7% had type 2 diabetes. The mean duration of diabetes was 15.3 years. The overall satisfaction level was 80.4%. The highest satisfaction rate was in the interpersonal manner (mean 4.45) while the lowest was in accessibility to an ophthalmologist when a referral was needed (mean 3.01). Some 60% of the participants were concerned it might take a long time to be referred to an ophthalmologist when it is needed. Some 90.1% found it easier to have diabetic retinopathy (DR) screening during routine diabetes follow up. Some 23.9% did not like the idea of only seeing the ophthalmologist when it is necessary and only 9.8% had some doubts of the doctor’s ability to diagnose DR by evaluating retina photos only. No significant association was found between patient’s satisfaction and demographic background or diabetes history. Conclusion: Patients were found to be highly satisfied with tele-retinal screening program. Mostly the reason of dissatisfaction was found in accessibility to an ophthalmologist when a referral was needed. Therefore, it is important to reassure patients that timely referral for effective intervention is performed and part of the screening policies.
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Affiliation(s)
- Atheer Alhumud
- Ophthalmology, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, SAU
| | - Fadwa Al Adel
- Surgery, Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, SAU
| | - Manal Alwazae
- Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, SAU
| | - Ghadeer Althaqib
- Ophthalmology, Princess Nourah Bint Abdulrahman University (PNU), Riyadh , SAU
| | - Atheer Almutairi
- Ophthalmology, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, SAU
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Patient perceived value of teleophthalmology in an urban, low income US population with diabetes. PLoS One 2020; 15:e0225300. [PMID: 31917793 PMCID: PMC6952085 DOI: 10.1371/journal.pone.0225300] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 11/01/2019] [Indexed: 12/02/2022] Open
Abstract
Dilated eye exams are the standard of care to detect advancing, vision threatening, but often asymptomatic retinopathy in a timely fashion, allowing for vision preserving treatments. Annual exam rates are suboptimal, especially in underserved populations. Although teleophthalmology programs tremendously improve annual exam rates in low income/under resourced settings, widespread adoption is limited. Using a mixed methods approach, three focus groups and individual interviews were conducted for patients with type 2 diabetes (N = 23) who had a teleophthalmology exam or a dilated eye exam. A survey and discussion assessed patients’ perspectives and value of teleophthalmology, including willingness to pay (WTP). Financial, transportation, and motivational barriers to obtaining an annual dilated eye exam were identified. Patients greatly valued having primary care (PC) based teleophthalmology for its convenience and ability to detect disease to allow for timely treatment and would recommend such a service. Although their WTP was at least the amount of their usual copay, cost was universally cited as a concern. Having a conveniently offered PC based teleophthalmology exam was valued. Educating patients on the value and costs of having such exams may be helpful to encourage informed discussions on eye care, especially in low income, underserved populations. Our study is among the few to provide insight on the value and perceptions of teleophthalmology in US low income, urban minority populations needed to help increase uptake of this innovation. Using surveys followed by facilitated discussion allowed for richer and more varied responses.
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Maa AY, Medert CM, Lu X, Janjua R, Howell AV, Hunt KJ, McCord S, Giangiacomo A, Lynch MG. Diagnostic Accuracy of Technology-based Eye Care Services. Ophthalmology 2020; 127:38-44. [DOI: 10.1016/j.ophtha.2019.07.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/01/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022] Open
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Pradeepa R, Rajalakshmi R, Mohan V. Use of Telemedicine Technologies in Diabetes Prevention and Control in Resource-Constrained Settings: Lessons Learned from Emerging Economies. Diabetes Technol Ther 2019; 21:S29-S216. [PMID: 31169429 DOI: 10.1089/dia.2019.0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Telemedicine is a promising strategy that utilizes telecommunication to provide health care in remote areas, facilitating beneficial interaction between the health care provider and people in rural areas and making affordable and accessible medical care available to remote, inaccessible areas of the world. This article provides an overview of some of the ways telemedicine is improving diabetes care outcomes at the community level. Telemedicine can play a number of roles in moving quality diabetes care forward. It is currently being used to create awareness among urban and rural population about the risk factors and prevention of diabetes; to facilitate patient monitoring; for remote diabetic retinopathy screening; and in diabetes prevention at the primary, secondary, and tertiary level. We also highlight the use of automated artificial intelligence software combined with telemedicine to conduct efficient real-time screening of complications such as diabetic retinopathy in remote areas where such facilities are currently unavailable.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Ramachandran Rajalakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
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20
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Bassi A, John O, Praveen D, Maulik PK, Panda R, Jha V. Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e11440. [PMID: 30368435 PMCID: PMC6229512 DOI: 10.2196/11440] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. Objective We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. Methods A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. Results The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. Conclusions In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.
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Affiliation(s)
- Abhinav Bassi
- George Institute for Global Health, India, New Delhi, India
| | - Oommen John
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia
| | - Devarsetty Praveen
- University of New South Wales, Sydney, Australia.,George Institute for Global Health, India, Hyderabad, India
| | - Pallab K Maulik
- George Institute for Global Health, India, New Delhi, India.,University of New South Wales, Sydney, Australia.,George Institute for Global Health, Oxford University, Oxford, United Kingdom
| | - Rajmohan Panda
- George Institute for Global Health, India, New Delhi, India
| | - Vivekanand Jha
- George Institute for Global Health, India, New Delhi, India.,University of Oxford, Oxford, United Kingdom
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Serrano CI, Shah V, Abràmoff MD. Use of Expectation Disconfirmation Theory to Test Patient Satisfaction with Asynchronous Telemedicine for Diabetic Retinopathy Detection. Int J Telemed Appl 2018; 2018:7015272. [PMID: 30405712 PMCID: PMC6201495 DOI: 10.1155/2018/7015272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/10/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of the study is to extend research on patient satisfaction with telemedicine services by employing the theoretical framework of Expectation Disconfirmation Theory (EDT) for diabetic retinopathy screenings focusing on rural patients. METHOD Adult subjects (n=220) with diabetes were recruited from a single family practice office in rural Iowa. Subjects completed a "pre" survey concerning their forward-looking perceptions of telemedicine prior to using telemedicine for detection of diabetic retinopathy and a "post" survey after they received recommendations from the distant ophthalmologists. RESULTS All hypotheses of the EDT model were supported. Patient satisfaction is influenced by both patients' expectations (P<.001) and disconfirmation of expectations (P<.001), and patient satisfaction has a positive impact on patient preference for telemedicine services (P<.001). Overall, patients who received telemedicine services were highly satisfied with telemedicine and developed a favorable disposition towards telemedicine services. CONCLUSIONS The EDT model is a viable framework to study patient satisfaction of telemedicine services. While previous feasibility studies have shown that telemedicine for diabetic retinopathy screenings yields diagnostic efficacy, this study applies a theoretical framework to demonstrate the viability of telemedicine for diabetic retinopathy screenings in rural areas.
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Affiliation(s)
- Christina I. Serrano
- Department of Computer Information Systems, Colorado State University, Fort Collins, CO, USA
| | - Vishal Shah
- Department of Business Information Systems, Central Michigan University, Mt. Pleasant, MI, USA
| | - Michael D. Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
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Mohammadpour M, Heidari Z, Mirghorbani M, Hashemi H. Smartphones, tele-ophthalmology, and VISION 2020. Int J Ophthalmol 2017; 10:1909-1918. [PMID: 29259912 PMCID: PMC5733521 DOI: 10.18240/ijo.2017.12.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
Telemedicine is an emerging field in recent medical achievements with rapid development. The "smartphone" availability has increased in both developed and developing countries even among people in rural and remotes areas. Tele-based services can be used for screening ophthalmic diseases and also monitoring patients with known diseases. Electronic ophthalmologic records of the patients including captured images by smartphones from anterior and posterior segments of the eye will be evaluated by ophthalmologists, and if patients require further evaluations, they will be referred to experts in the relevant field. Eye diseases such as cataract, glaucoma, age-related macular degeneration, diabetic retinopathy, and retinopathy of prematurity are the most common causes of blindness in many countries and beneficial use of teleophthalmology with smartphones will be a good way to achieve the aim of VISION 2020 all over the world. Numerous studies have shown that teleophthalmology is similar to the conventional eye care system in clinical outcomes and even provides more patient satisfaction as it saves time and cost. This review explains how teleophthalmology helps to improve patient outcomes through smartphones.
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Affiliation(s)
- Mehrdad Mohammadpour
- Farabi Eye Hospital, Ophthalmology Department and Eye Research Center, Tehran University of Medical Sciences, Tehran 1336616351, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1968653111, Iran
| | - Zahra Heidari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1968653111, Iran
- Department of Rehabilitation Science, Mazandaran University of Medical Sciences, Sari 4815733971, Iran
| | - Masoud Mirghorbani
- Farabi Eye Hospital, Ophthalmology Department and Eye Research Center, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1968653111, Iran
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Woodward MA, Musch DC, Hood CT, Greene JB, Niziol LM, Jeganathan VSE, Lee PP. Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability. Cornea 2017; 36:1159-1165. [PMID: 28820791 PMCID: PMC5646384 DOI: 10.1097/ico.0000000000001294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Corneal and anterior segment diseases cause most of the urgent visits to eye care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from 2 portable cameras for telemedicine purposes. METHODS This is a prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A cornea specialist provided the gold standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for the presence of pathology. Accuracy to detect disease was compared with gold standard diagnosis, stratified by the camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). RESULTS A total of 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54% to 71% for the iTouch and 66% to 75% for the Nidek, across graders; specificity ranged from 82% to 96% for the iTouch and 91% to 98% for the Nidek. The intergrader reliability was moderate to strong (kappa ranges: 0.54-0.71 for the iTouch; 0.75-0.76 for the Nidek). Quality ratings were variable between graders. CONCLUSIONS External photographs taken by standard, nonenhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.
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Affiliation(s)
- Maria A Woodward
- *Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
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Valikodath NG, Leveque TK, Wang SY, Lee PP, Newman-Casey PA, Hansen SO, Woodward MA. Patient Attitudes Toward Telemedicine for Diabetic Retinopathy. Telemed J E Health 2017; 23:205-212. [PMID: 27336678 PMCID: PMC5359684 DOI: 10.1089/tmj.2016.0108] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Diabetic retinopathy (DR) is the leading cause of new-onset blindness in adults. Telemedicine is a validated, cost-effective method to improve monitoring. However, little is known of patients' attitudes toward telemedicine for DR. Our study explores factors that influence patients' attitudes toward participating in telemedicine. MATERIALS AND METHODS Ninety seven participants in a university and the Veterans Administration setting completed a survey. Only people with diabetes mellitus (DM) were included. The main outcome was willingness to participate in telemedicine. The other outcomes were perceived convenience and impact on the patient-physician relationship. Participants reported demographic information, comorbidities, and access to healthcare. Analysis was performed with t-tests and multivariable logistic regression. RESULTS Demographic factors were not associated with the outcomes (all p > 0.05). Patients had decreased odds of willingness if they valued the patient-physician relationship (adjusted odds ratio [OR] = 0.08, confidence interval [CI] = 0.02-0.35, p = 0.001) or had a longer duration of diabetes (adjusted OR = 0.93, CI = 0.88-0.99, p = 0.02). Patients had increased odds of willingness if they perceived increased convenience (adjusted OR = 8.10, CI = 1.77-36.97, p = 0.01) or had more systemic comorbidities (adjusted OR = 1.85, CI = 1.10-3.11, p = 0.02). DISCUSSION It is critical to understand the attitudes of people with DM where telemedicine shows promise for disease management and end-organ damage prevention. Patients' attitudes are influenced by their health and perceptions, but not by their demographics. Receptive patients focus on convenience, whereas unreceptive patients strongly value their patient-physician relationships or have long-standing DM. Telemedicine monitoring should be designed for people who are in need and receptive to telemedicine.
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Affiliation(s)
- Nita G. Valikodath
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Thellea K. Leveque
- Department of Ophthalmology, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Sophia Y. Wang
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sean O. Hansen
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
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Maa AY, Wojciechowski B, Hunt KJ, Dismuke C, Shyu J, Janjua R, Lu X, Medert CM, Lynch MG. Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative. Ophthalmology 2017; 124:539-546. [PMID: 28081944 DOI: 10.1016/j.ophtha.2016.11.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The aging population is at risk of common eye diseases, and routine eye examinations are recommended to prevent visual impairment. Unfortunately, patients are less likely to seek care as they age, which may be the result of significant travel and time burdens associated with going to an eye clinic in person. A new method of eye-care delivery that mitigates distance barriers and improves access was developed to improve screening for potentially blinding conditions. We present the quality data from the early experience (first 13 months) of Technology-Based Eye Care Services (TECS), a novel ophthalmologic telemedicine program. DESIGN With TECS, a trained ophthalmology technician is stationed in a primary care clinic away from the main hospital. The ophthalmology technician follows a detailed protocol that collects information about the patient's eyes. The information then is interpreted remotely. Patients with possible abnormal findings are scheduled for a face-to-face examination in the eye clinic. PARTICIPANTS Any patient with no known ocular disease who desires a routine eye screening examination is eligible. METHODS Technology-Based Eye Care Services was established in 5 primary care clinics in Georgia surrounding the Atlanta Veterans Affairs hospital. MAIN OUTCOME MEASURES Four program operation metrics (patient satisfaction, eyeglass remakes, disease detection, and visit length) and 2 access-to-care metrics (appointment wait time and no-show rate) were tracked. RESULTS Care was rendered to 2690 patients over the first 13 months of TECS. The program has been met with high patient satisfaction (4.95 of 5). Eyeglass remake rate was 0.59%. Abnormal findings were noted in 36.8% of patients and there was >90% agreement between the TECS reading and the face-to-face findings of the physician. TECS saved both patient (25% less) and physician time (50% less), and access to care substantially improved with 99% of patients seen within 14 days of contacting the eye clinic, with a TECS no-show rate of 5.2%. CONCLUSIONS The early experience with TECS has been promising. Tele-ophthalmology has the potential to improve operational efficiency, reduce cost, and significantly improve access to care. Although further study is necessary, TECS shows potential to help prevent avoidable vision loss.
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Affiliation(s)
- April Y Maa
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Barbara Wojciechowski
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kelly J Hunt
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Clara Dismuke
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph A. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Jason Shyu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Rabeea Janjua
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Xiaoqin Lu
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | | | - Mary G Lynch
- Ophthalmology Division, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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Maa AY, Patel S, Chasan JE, Delaune W, Lynch MG. Retrospective Evaluation of a Teleretinal Screening Program in Detecting Multiple Nondiabetic Eye Diseases. Telemed J E Health 2017; 23:41-48. [DOI: 10.1089/tmj.2016.0039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- April Y. Maa
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Shivangi Patel
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
| | - Joel E. Chasan
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - William Delaune
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, Georgia
| | - Mary G. Lynch
- Ophthalmology Division, Atlanta VA Medical Center, Decatur, Georgia
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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DeBuc DC. The Role of Retinal Imaging and Portable Screening Devices in Tele-ophthalmology Applications for Diabetic Retinopathy Management. Curr Diab Rep 2016; 16:132. [PMID: 27841014 DOI: 10.1007/s11892-016-0827-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In the years since its introduction, retinal imaging has transformed our capability to visualize the posterior pole of the eye. Increasing practical advances in mobile technology, regular monitoring, and population screening for diabetic retinopathy management offer the opportunity for further development of cost-effective applications through remote assessment of the diabetic eye using portable retinal cameras, smart-phone-based devices and telemedicine networks. Numerous retinal imaging methods and mobile technologies in tele-ophthalmology applications have been reported for diabetic retinopathy screening and management. They provide several advantages of automation, sensitivity, specificity, portability, and miniaturization for the development of point-of-care diagnostics for eye complications in diabetes. The aim of this paper is to review the role of retinal imaging and mobile technologies in tele-ophthalmology applications for diabetic retinopathy screening and management. At large, although improvements in current technology and telemedicine services are still needed, telemedicine has demonstrated to be a worthy tool to support health caregivers in the effective management and prevention of diabetes and its complications.
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Affiliation(s)
- Delia Cabrera DeBuc
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA.
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Abstract
According to current projections, the number of Americans with diabetes mellitus will increase from 27.8 million in 2007 to 60.7 million in 2030. With the increasing gap between demand for eye care and supply of ophthalmologists and optometrists, and the non-uniform distribution of eye care providers in US counties, barriers to eye examinations will likely increase. Telemedicine assessment of diabetic retinal disease through remote retinal imaging and diagnosis has the potential to meet these growing demands. To establish evidence for a telemedicine program as an effective modality for diabetic retinopathy (DR) assessment, the interpretation of teleretinal images should compare favorably with Early Treatment Diabetic Retinopathy Study film or digital photographs. We review the current evidence on the critical features and characteristics of ocular telehealth programs for DR in the following categories: image gradability, mydriasis, sensitivity and specificity, cost-effectiveness, long-term effectiveness, patient comfort and satisfaction, and improvement of patient related outcomes.
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Affiliation(s)
- Aditi Gupta
- a Beetham Eye Institute, Joslin Diabetes Center , Boston , MA , USA
| | - Jerry Cavallerano
- a Beetham Eye Institute, Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Jennifer K Sun
- a Beetham Eye Institute, Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Paolo S Silva
- a Beetham Eye Institute, Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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29
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Tan IJ, Dobson LP, Bartnik S, Muir J, Turner AW. Real-time teleophthalmology versus face-to-face consultation: A systematic review. J Telemed Telecare 2016; 23:629-638. [PMID: 27444188 DOI: 10.1177/1357633x16660640] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Advances in imaging capabilities and the evolution of real-time teleophthalmology have the potential to provide increased coverage to areas with limited ophthalmology services. However, there is limited research assessing the diagnostic accuracy of face-to-face teleophthalmology consultation. This systematic review aims to determine if real-time teleophthalmology provides comparable accuracy to face-to-face consultation for the diagnosis of common eye health conditions. Methods A search of PubMed, Embase, Medline and Cochrane databases and manual citation review was conducted on 6 February and 7 April 2016. Included studies involved real-time telemedicine in the field of ophthalmology or optometry, and assessed diagnostic accuracy against gold-standard face-to-face consultation. The revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool assessed risk of bias. Results Twelve studies were included, with participants ranging from four to 89 years old. A broad number of conditions were assessed and include corneal and retinal pathologies, strabismus, oculoplastics and post-operative review. Quality assessment identified a high or unclear risk of bias in patient selection (75%) due to an undisclosed recruitment processes. The index test showed high risk of bias in the included studies, due to the varied interpretation and conduct of real-time teleophthalmology methods. Reference standard risk was overall low (75%), as was the risk due to flow and timing (75%). Conclusion In terms of diagnostic accuracy, real-time teleophthalmology was considered superior to face-to-face consultation in one study and comparable in six studies. Store-and-forward image transmission coupled with real-time videoconferencing is a suitable alternative to overcome poor internet transmission speeds.
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Affiliation(s)
- Irene J Tan
- 1 Lions Outback Vision, Lions Eye Institute, Australia
| | - Lucy P Dobson
- 1 Lions Outback Vision, Lions Eye Institute, Australia
| | - Stephen Bartnik
- 1 Lions Outback Vision, Lions Eye Institute, Australia.,2 Sydney School of Public Health, University of Sydney, Australia
| | - Josephine Muir
- 1 Lions Outback Vision, Lions Eye Institute, Australia.,3 Centre for Ophthalmology and Visual Science, University of Western Australia, Australia
| | - Angus W Turner
- 1 Lions Outback Vision, Lions Eye Institute, Australia.,3 Centre for Ophthalmology and Visual Science, University of Western Australia, Australia
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Abstract
Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes.
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Sim DA, Mitry D, Alexander P, Mapani A, Goverdhan S, Aslam T, Tufail A, Egan CA, Keane PA. The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening. J Diabetes Sci Technol 2016; 10:308-17. [PMID: 26830492 PMCID: PMC4773982 DOI: 10.1177/1932296816629983] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions.
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Affiliation(s)
- Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, Croydon University Hospital, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Danny Mitry
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Philip Alexander
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adam Mapani
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Srini Goverdhan
- University of Southampton, Southampton Eye Unit, Southampton, UK
| | - Tariq Aslam
- Manchester University, Manchester Royal Eye Hospital, Manchester, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
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Das T, Raman R, Ramasamy K, Rani PK. Telemedicine in diabetic retinopathy: current status and future directions. Middle East Afr J Ophthalmol 2015; 22:174-8. [PMID: 25949074 PMCID: PMC4411613 DOI: 10.4103/0974-9233.154391] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Telemedicine is exchange of medical data by electronic telecommunications technology that allows a patient's medical problems evaluated and monitored by a remotely located physician. Over the years, telemedicine and telescreening have become important components in health care, in both disease detection and treatment. Highly visual and image intensive ophthalmology is uniquely suited for telemedicine. Because of rising disease burden coupled with high opportunity cost in detection, diabetic retinopathy is an ideal ophthalmic disease for telescreening and decision-making. It fits to Wilson and Jungner's all 10 criteria of screening for chronic diseases and the American Telehealth Association's 4 screening categories.
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Affiliation(s)
| | - Rajiv Raman
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kim Ramasamy
- Aravind Eye Care System, Madurai, Tamil Nadu, India
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Thomas SM, Jeyaraman M, Hodge WG, Hutnik C, Costella J, Malvankar-Mehta MS. The effectiveness of teleglaucoma versus in-patient examination for glaucoma screening: a systematic review and meta-analysis. PLoS One 2014; 9:e113779. [PMID: 25479593 PMCID: PMC4257598 DOI: 10.1371/journal.pone.0113779] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/29/2014] [Indexed: 12/02/2022] Open
Abstract
Background Glaucoma is the leading cause of irreversible visual impairment in the world affecting 60.5 million people worldwide in 2010, which is expected to increase to approximately 79.6 million by 2020. Therefore, glaucoma screening is important to detect, diagnose, and treat patients at the earlier stages to prevent disease progression and vision loss. Teleglaucoma uses stereoscopic digital imaging to take ocular images, which are transmitted electronically to an ocular specialist. The purpose is to synthesize literature to evaluate teleglaucoma, its diagnostic accuracy, healthcare system benefits, and cost-effectiveness. Methods A systematic search was conducted to help locate published and unpublished studies. Studies which evaluate teleglaucoma as a screening device for glaucoma were included. A meta-analysis was conducted to provide estimates of diagnostic accuracy, diagnostic odds ratio, and the relative percentage of glaucoma cases detected. The improvements to healthcare service quality and cost data were assessed. Results Of 11237 studies reviewed, 45 were included. Our results indicated that, teleglaucoma is more specific and less sensitive than in-person examination. The pooled estimates of sensitivity was 0.832 [95% CI 0.770, 0.881] and specificity was 0.790 [95% CI 0.668, 0.876]. The relative odds of a positive screen test in glaucoma cases are 18.7 times more likely than a negative screen test in a non-glaucoma cases. Additionally, the mean cost for every case of glaucoma detected was $1098.67 US and of teleglaucoma per patient screened was $922.77 US. Conclusion Teleglaucoma can accurately discriminate between screen test results with greater odds for positive cases. It detects more cases of glaucoma than in-person examination. Both patients and the healthcare systems benefit from early detection, reduction in wait and travel times, increased specialist referral rates, and cost savings. Teleglaucoma is an effective screening tool for glaucoma specifically for remote and under-services communities.
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Affiliation(s)
- Sera-Melisa Thomas
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- * E-mail:
| | - Maya Jeyaraman
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - William G. Hodge
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada
| | - Cindy Hutnik
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada
| | - John Costella
- Allyn and Betty Taylor Library, Western University, London, Canada
| | - Monali S. Malvankar-Mehta
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, London, Canada
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Abstract
Over the past decade, there have been rapid strides in progress in the fields of telecommunication and medical imaging. There is growing evidence regarding use of teleophthalmology for screening of diabetic retinopathy. This article highlights some pertinent questions regarding use of telescreening for diabetic retinopathy. It deals with evidence regarding accuracy of diagnosis, patients satisfaction and cost-effectiveness. The American Telemedicine Association have given certain guidelines for teleheath practices for diabetic retinopathy. The article discusses regarding these guidelines. Finally, a working model for diabetic retinopathy screening through teleophthalmology has been described. Telescreening for diabetic retinopathy seems to be a cost-effective, accurate, and reliable method for screening for diabetic retinopathy. The American Telemedicine Association has set up guidelines for telescreening that should be adhered to provide quality screening services to people with diabetes.
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Affiliation(s)
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, Chennai, India
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Mohan V, Prathiba V, Pradeepa R. Tele-diabetology to Screen for Diabetes and Associated Complications in Rural India: The Chunampet Rural Diabetes Prevention Project Model. J Diabetes Sci Technol 2014; 8:256-261. [PMID: 24876575 PMCID: PMC4455413 DOI: 10.1177/1932296814525029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes, with its acute and long-term complications, has become a major health hazard in developing countries. An estimated 62.4 million people in India have diabetes. With increasing urbanization and industrialization, we can expect huge numbers of people with diabetes in India in the future. Moreover, all diabetes efforts in India are currently focused in urban areas while 70% of India's population actually lives in rural areas. The current statistics demonstrates that urgent interventions are mandatory to curb the epidemic of diabetes and its complications at the grassroots level. This gap in providing diabetes care can be nullified by the use of tele-diabetology. This holds great potential to overcome barriers and improve quality and access to diabetes care to remote, underserved areas of developing counties. The Chunampet Rural Diabetes Prevention Project (CRDPP) has been developed and tested as a successful model for screening and delivering diabetes care to rural areas in developing countries. Using a tele-diabetology mobile van loaded with appropriate equipment, trained technicians, and satellite technology helped us to screen for diabetes and its complications and deliver diabetes care to remote villages in southern India. The Chunampet model can be applied in reaching out to remote areas where specialized diabetes care facilities may not be available.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre for Education, Gopalapuram, Chennai, India
| | - Vijayaraghavan Prathiba
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre for Education, Gopalapuram, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention & Control, IDF Centre for Education, Gopalapuram, Chennai, India
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Vaziri K, Moshfeghi DM, Moshfeghi AA. Feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration. Semin Ophthalmol 2013; 30:81-95. [PMID: 24171781 DOI: 10.3109/08820538.2013.825727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Age-related macular degeneration and diabetic retinopathy are important causes of visual impairment and blindness in the world. Because of recent advances and newly available treatment modalities along with the devastating consequences associated with late stages of these diseases, much attention has been paid to the importance of early detection and improving patient access to specialist care. Telemedicine or, more specifically, digital retinal imaging utilizing telemedical technology has been proposed as an important alternative screening and management strategy to help meet this demand. In this paper, we perform a literature review and analysis that evaluates the validity and feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration. Understanding both the progress and barriers to progress that have been demonstrated in these two areas is important for future telemedicine research projects and innovations in telemedicine technology.
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Affiliation(s)
- Kamyar Vaziri
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Palm Beach Gardens , Florida , USA and
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37
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Telescreening for Diabetic Retinopathy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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John S, Sengupta S, Reddy SJ, Prabhu P, Kirubanandan K, Badrinath SS. The Sankara Nethralaya mobile teleophthalmology model for comprehensive eye care delivery in rural India. Telemed J E Health 2012; 18:382-7. [PMID: 22500741 DOI: 10.1089/tmj.2011.0190] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Teleophthalmology holds great potential to overcome barriers and improve quality, access, and affordability in eye care. We introduced mobile units for comprehensive eye care delivery and have successfully conducted eye camps over the past 1.5 years. METHODS Here we describe the current process and review results of conducting comprehensive eye camps with the aid of teleophthalmology mobile units and determine major causes of avoidable blindness in central and south India. Retrospective chart reviews of all the camps were done as a part of the rural teleophthalmology project of Sankara Nethralaya during the period of April 2009-September 2010. Speciality consultation was achieved by means of teleophthalmology during which images were converted to Digital Imaging and Communications in Medicine standard and transferred to the base hospital by a satellite link using a very small aperture terminal at 256-384 kilobits per second with store-and-forward technology as well as real-time videoconferencing when possible. In addition to comprehensive examination, schoolteachers were trained to assess visual acuity, and various public awareness activities were undertaken. RESULTS Over the 1.5-year study period, 54,751 patients underwent evaluation at 872 camps across four states in India. Among these, uncorrected refractive error was the commonest cause of avoidable blindness (59%), followed by cataract (30%). Retinal diseases, mainly diabetic retinopathy, contributed 3.3% of avoidable blindness, and corneal diseases accounted for another 1%. CONCLUSIONS Comprehensive eye camps utilizing a mobile teleophthalmology unit appears to be a very useful tool to improve eye care delivery in the developing world.
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Affiliation(s)
- Sheila John
- Department of Teleophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
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Prathiba V, Rema M. Teleophthalmology: a model for eye care delivery in rural and underserved areas of India. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:683267. [PMID: 22295192 PMCID: PMC3263845 DOI: 10.1155/2011/683267] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 03/15/2011] [Accepted: 04/03/2011] [Indexed: 05/27/2023]
Abstract
Objectives. To describe the application of teleophthalmology in rural and underserved areas of India. Study Design. This paper describes the major teleophthalmology projects in India and its benefits. Results. Teleophthalmology is the use of telecommunication for electronic transfer of health-related data from rural and underserved areas of India to specialities in urban cities. The MDRF/WDF Rural Diabetes Project has proved to be very beneficial for improvement of quality health care in Tamilnadu and can be replicated at the national level. This community outreach programme using telemedicine facilities has increased awareness of eye diseases, improved access to specialized health care, helped in local community empowerment, and provided employment opportunities. Early detection of sight threatening disorders by teleophthalmology and prompt treatment can help decrease visual impairment. Conclusion. Teleophthalmology can be a very effective model for improving eye care delivery system in rural and underserved areas of India.
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Affiliation(s)
- Vijayaraghavan Prathiba
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research
Foundation, 6 Conran Smith Road Gopalapuram, Chennai 600086, India
| | - Mohan Rema
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research
Foundation, 6 Conran Smith Road Gopalapuram, Chennai 600086, India
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Whitten P, Holtz B, Laplante C. Telemedicine: What have we learned? Appl Clin Inform 2010; 1:132-41. [PMID: 23616832 DOI: 10.4338/aci-2009-12-r-0020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/15/2010] [Indexed: 12/12/2022] Open
Abstract
As the health care industry is facing many challenges and is undergoing extensive change, telemedicine is in the position to address these challenges and be an important part of health care's development. Telemedicine has been used for approximately a half century, in which researchers have explored the different technologies utilized, clinical outcomes, cost benefits, perceptions, and adoption challenges of its use. This paper reviews and summarizes these findings and presents possible future research endeavors. Examining what is known about telemedicine can aid in the development of innovative, sustainable and beneficial health technologies that could positively impact health care delivery and outcomes.
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Durrani H, Khoja S. A systematic review of the use of telehealth in Asian countries. J Telemed Telecare 2009; 15:175-81. [PMID: 19471028 DOI: 10.1258/jtt.2009.080605] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a systematic review of the literature on telehealth in Asia. The Medline database was searched, together with three specialist journals, for peer-reviewed articles published in the ten years to June 2007 which were related to any telehealth application involving one or more Asian country. Out of the 1504 abstracts retrieved, 109 articles were selected by two independent reviewers for the final review. The number of published articles on telehealth in Asia increased during the review period. The largest number of studies were conducted in Japan (37%). Most telehealth applications were based on the store-and-forward modality (43%), with 35% using videoconferencing and 15% using a hybrid approach. Most of the studies were descriptive (75%) and only eight included a control group against which telehealth was compared. The most common means of telecommunication was ISDN lines, which were employed in 32% of the studies. Some 40% of the studies mentioned improved quality of health care; about 20% mentioned improved access to health care. Although most studies mentioned cost, only 13 of them assessed resource utilization and cost. The overall findings gave a generally optimistic picture of telehealth in Asia. However, there is a lack of good quality studies.
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Affiliation(s)
- Hammad Durrani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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Meher SK, Tyagi RS, Chaudhry T. Awareness and attitudes to telemedicine among doctors and patients in India. J Telemed Telecare 2009; 15:139-41. [DOI: 10.1258/jtt.2009.003011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We collected information about awareness and attitudes to telemedicine from 143 doctors at 14 different hospitals in India, and from 121 patients who had come to New Delhi for treatment from other parts of India. Most doctors felt that telemedicine was important and their opinions were similar in all age groups. Only three of the 14 hospitals had not implemented telemedicine. A total of 86 doctors had used telemedicine. One hundred of the 121 patients were not aware of telemedicine. However, when the concept was explained, most patients had a positive attitude towards telemedicine. The majority of patients who had previously used telemedicine ( n = 7) found it satisfactory. It is important that proper hospital training programmes should be organized for all doctors, which will assist in future utilization of telemedicine. Further awareness programmes are also required for patients.
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Affiliation(s)
- Sushil K Meher
- Department of Computer Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
| | - Rajeshwar S Tyagi
- Department of Computer Facility, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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References. J Telemed Telecare 2007. [DOI: 10.1258/135763307782213534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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