Remote assessment boosts diabetic retinopathy screening
medwireNews: Results of a US study suggest that implementation of a primary care-based teleretinal diabetic retinopathy screening (TDRS) program could improve access to screening and maximize efficiency.
Lauren Daskivich (Department of Health Services, Los Angeles County, California, USA) and fellow researchers compared rates of DR screening and waiting times before and after initiation of the TDRS program in Los Angeles County.
The team found that 40.6% of 14,633 patients with diabetes and two or more primary care visits underwent annual DR screening between 2011 and 2012, before implementation of the screening program. By comparison, 56.9% of 13,133 attended screening following the intervention in 2014–2015, a significant difference.
Furthermore, the median time to DR screening decreased significantly from 158 days at baseline to 17 days after initiation of the program, giving an 89.2% reduction in waiting time for screening.
“[W]e are able to increase the number of patients screened for DR without increasing demand on specialty care, which is critical in a system in which more than 3000 people are currently waiting for eye care appointments,” write the authors in JAMA Internal Medicine.
They explain that TDRS increases accessibility by screening through primary – rather than specialty – care, and “improves efficiency by moving patients with normal retinal photographs out of the queue for appointments with specialty care professionals.”
Indeed, of a total 21,222 patients who underwent screening, 68.8% did not require referral to an ophthalmologist, meaning that “the need for more than 14 000 visits to specialty care professionals was eliminated.”
The authors of an accompanying commentary, Courtney Lyles and Urmimala Sarkar (both from University of California, San Francisco, USA), highlight that the TDRS program combined “several evidence-based strategies for health system innovations,” which “produced improved provision of care without large increases in cost.”
However, they note that “[a]lthough these implementation solutions seem straightforward and clear, they actually represent cultural shifts in work responsibilities, as well as expectations on the part of both primary care and specialty professionals and staff.”
Lyles and Sarkar add that “ideas of teams must be somewhat reshaped for programs such as this one to succeed,” and emphasize that “[i]mproving screening of DR is a key public health priority, given that diabetes is the leading cause of preventable blindness in the United States.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2017 Springer Healthcare part of the Springer Nature group