Fonda Stephanie J, Bursell Sven-Erik, Lewis Drew G, Garren Jeonifer, Hock Kristen, Cavallerano Jerry
Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Telemed J E Health. 2007 Dec;13(6):635-44. doi: 10.1089/tmj.2007.0025.
Several studies suggest that telehealth eye care programs that combine retinal imaging, education, and some care management can improve patient adherence to annual, comprehensive eye examinations and follow-up treatments. Little is known, however, about whether such programs relate to other, more distal outcomes that affect diabetic eye disease, such as blood glucose control. This paper assesses the relationship of participation in a diabetes telehealth eye care program with standard, face-to-face eye care as well as improvements in other diabetes-related health outcomes. We conducted a retrospective study using data from electronic medical records of Joslin Diabetes Center (n=13,752). The data span 2 years: baseline and follow-up. Subjects' eye care groups were no eye care, eye care outside of the clinic, standard eye care at the clinic, or participation in the Joslin Vision Network telehealth eye care program. We analyzed the relationship of participation in the telehealth eye care program at baseline to follow-up eye care groups and changes in hemoglobin A1c, low density lipoprotein levels, and systolic blood pressure. The results show that participation in the telehealth eye care program was significantly correlated with whether subjects later obtained standard eye care, improvement in hemoglobin A1c, and improvement in low density lipoprotein. Thus, telehealth eye care programs that incorporate evaluation, education, and care planning are related to use of recommended eye care and improvements in certain diabetes-related health outcomes. Such programs can address the many aspects of care necessary to reduce risk of vision loss due to diabetic retinopathy and other diabetes-related complications. Future research might test hypotheses suggested by sociological and psychological theories regarding causation between participation in a telehealth eye care program and other diabetes care.
多项研究表明，将视网膜成像、教育及部分护理管理相结合的远程医疗眼科护理项目，可提高患者对年度全面眼科检查及后续治疗的依从性。然而，对于此类项目是否与影响糖尿病眼病的其他更长远结果（如血糖控制）相关，我们却知之甚少。本文评估了参与糖尿病远程医疗眼科护理项目与标准面对面眼科护理的关系，以及在其他糖尿病相关健康结果方面的改善情况。我们利用乔斯林糖尿病中心电子病历数据（n = 13752）进行了一项回顾性研究。数据涵盖两年：基线期和随访期。受试者的眼科护理组分为无眼科护理、诊所外眼科护理、诊所标准眼科护理或参与乔斯林视力网络远程医疗眼科护理项目。我们分析了基线期参与远程医疗眼科护理项目与随访期眼科护理组的关系，以及糖化血红蛋白、低密度脂蛋白水平和收缩压的变化。结果显示，参与远程医疗眼科护理项目与受试者后来是否接受标准眼科护理、糖化血红蛋白的改善以及低密度脂蛋白的改善显著相关。因此，纳入评估、教育和护理计划的远程医疗眼科护理项目与推荐眼科护理的使用以及某些糖尿病相关健康结果的改善有关。此类项目可解决降低糖尿病视网膜病变及其他糖尿病相关并发症导致视力丧失风险所需护理的诸多方面。未来研究可检验社会学和心理学理论提出的关于参与远程医疗眼科护理项目与其他糖尿病护理之间因果关系的假设。
