[Telemedicine monitoring for AMD patients]

INTRODUCTION

AMD follow-up is a public health issue in developed countries due to aging of the population and medical demographics. Telemedicine may be a means of improving follow-up.

PURPOSE

To compare the agreement between telemedicine and in-person consultations in terms of indications for intravitreal injections in exudative AMD patients.

MATERIALS AND METHODS

From January 2017 to April 2017, AMD patients followed on a PRN protocol at a single center, Rennes university medical center, were included. The telemedicine evaluation was read by two anonymous experts on the basis of the medical record including visual acuity and fundus photographs. The agreement between conventional follow-up and telemedicine in terms of indications for intravitreal injections, as well as interobserver agreement, were tested with the Cohen's kappa coefficient using SAS statistical software V9.4 (SAS Institute, Cary, NC).

RESULTS

In total, 104 eyes corresponding to 57 consultations for 42 patients were analyzed. The mean age was 82.12 years (standard deviation±6.4). Recommendations for anti-VEGF were similar between the standard and telemedicine visits in 97 % of cases. The Kappa coefficient was 0.8861 [0.76; 1.00], P<0.0001 for agreement between telemedicine and in-person consultation. The Kappa coefficient was 0.8441 [0.70; 0.99], P<0.0001 for interobserver agreement. We observed 5 cases of disagreement between the two observers.

DISCUSSION

The concordance was very good in our study. The few cases of disagreement resulted mainly from poorly interpretable examinations due to poor image quality, major macular changes in patients with a prior examination, and the fact that only a single cut was analyzed.

CONCLUSION

AMD monitoring by telemedicine seems promising and reliable. This approach would allow better follow-up of patients with difficult access to care.

Role of patient education in the perception and acceptance of home monitoring after recent implantation of cardioverter defibrillators: the EDUCAT study

BACKGROUND

Much attention is being paid to the education of and provision of medical information to patients, to optimize their understanding and acceptance of their disease.

AIMS

To ascertain the impact of educating recent recipients of an implantable cardioverter defibrillator (ICD) on their perception and acceptance of a home monitoring (HM) system.

METHODS

Questionnaire 1, completed one month after ICD implantation, was designed to assess: the quality of patient preparation for HM; patient comprehension of HM; and patient anxiety experienced during its installation. The comprehension questions were assigned a score of -2 for an incorrect answer, +1 for a correct answer and 0 for neither (total score ranging from -40 to +20). Questionnaire 2, completed six months after ICD implantation, assessed patient acceptance of and anxiety about HM.

RESULTS

The registry included 571 patients (mean age 63.9±12.8 years; 83% men; 76% of ICDs implanted for primary prevention) followed by HM for 6.2±1.2 months. Questionnaire 1 was completed by 430 (75.3%) patients and questionnaire 2 by 398 (69.7%) patients. Younger patients had a better comprehension of HM than older patients. High-quality training conditions improved the comprehension score, and a positive association was observed between anxiety and acceptance levels and the comprehension score. The 80±20% mean data transmission rate (days of transmission/days of follow-up ratio) was unrelated to the comprehension scores.

CONCLUSION

A clear understanding was associated with a higher acceptance of HM, although it was unrelated to the data transmission rate.