Kelly Simon P, Wallwork Ian, Haider David, Qureshi Kashif
Ophthalmology Department, Royal Bolton Hospital National Health Service Foundation Trust, Bolton, UK.
Clin Ophthalmol. 2011;5:1673-8. doi: 10.2147/OPTH.S26753. Epub 2011 Dec 1.
To describe a quality improvement for referral of National Health Service patients with macular disorders from a community optometry setting in an urban area.
Service evaluation of teleophthalmology consultation based on spectral domain optical coherence tomography images acquired by the community optometrist and transmitted to hospital eye services.
Fifty patients with suspected macular conditions were managed via telemedicine consultation over 1 year. Responses were provided by hospital eye service-based ophthalmologists to the community optometrist or patient within the next day in 48 cases (96%) and in 34 (68%) patients on the same day. In the consensus opinion of the optometrist and ophthalmologist, 33 (66%) patients required further "face-to-face" medical examination and were triaged on clinical urgency. Seventeen cases (34%) were managed in the community and are a potential cost improvement. Specialty trainees were supervised in telemedicine consultations.
Innovation and quality improvement were demonstrated in both optometry to ophthalmology referrals and in primary optometric care by use of telemedicine with spectral domain optical coherence tomography images. E-referral of spectral domain optical coherence tomography images assists triage of macular patients and swifter care of urgent cases. Teleophthalmology is also, in the authors' opinion, a tool to improve interdisciplinary professional working with community optometrists. Implications for progress are discussed.
描述在城市地区社区验光机构中，对患有黄斑疾病的国民健康服务患者进行转诊的质量改进情况。
基于社区验光师采集并传输至医院眼科服务部门的频域光学相干断层扫描图像，对远程眼科会诊进行服务评估。
在1年多的时间里，通过远程医疗会诊对50例疑似黄斑疾病患者进行了管理。医院眼科服务部门的眼科医生在次日对48例（96%）患者以及在同一天对34例（68%）患者向社区验光师或患者提供了回复。根据验光师和眼科医生的一致意见，33例（66%）患者需要进一步进行“面对面”医学检查，并根据临床紧急程度进行了分诊。17例（34%）患者在社区得到管理，这可能带来成本的降低。专业实习生在远程医疗会诊中得到了监督。
通过使用频域光学相干断层扫描图像进行远程医疗，在验光向眼科转诊以及初级验光护理方面都展现了创新和质量改进。频域光学相干断层扫描图像的电子转诊有助于黄斑疾病患者的分诊以及对紧急病例的更快治疗。作者认为，远程眼科也是一种改善与社区验光师跨学科专业协作的工具。文中还讨论了对未来发展的影响。
