Laboratoire d'Épidémiologie et de Santé Publique, Strasbourg, France.
Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
PLoS One. 2018 Oct 26;13(10):e0206375. doi: 10.1371/journal.pone.0206375. eCollection 2018.
In France, secondary care hospitals encounter difficulties to adhere to retinopathy of prematurity (ROP) screening guidelines. Our objective was to assess the effectiveness and efficacy of a tele-expertise program for ROP screening in neonatal intensive care units without on-site ophthalmologists. We evaluated the impact of a tele-expertise program funded by the Paris Region Health Authority in a secondary care center general hospital of the Paris Region (CHSF), where there was previously no on-site ophthalmologist. We performed an observational, controlled before-after study, with a university tertiary care center with on-site ophthalmologists (Port-Royal) as the control group. Recruitment and data collection for both periods took place from 1 January 2012 to 31 December 31 2012, and from 1 January 2014 to 31 March 2015. The primary endpoint was the percentage of compliance with screening guidelines, secondary endpoints included pain scores and costs. Over the two periods, at total of 351 infants were recruited in the CHSF. Implementation of the tele-expertise resulted in an absolute +57.3% increase in the proportion of examinations realized in accordance with guidelines (3.8% during the "before" period and 61.1% during the "after" period, p<0.001). As compared with the control group, the proportion of infants appropriately screened improved (57.5% versus 43.1%, p = 0.002); median pain score on the acute pain rating scale for neonates during examination was significantly higher (median score 5.5/10, range [2.5-5.7] versus 2.0/10, range [1.0-3.1], p = 0.002). Screening rates in the control group remained unchanged. The average cost per examination increased from €337 in the "before" period to €353 in the "after period" in the tele-expertise group. The implementation of tele-expertise for ROP screening in the CHSF medical center resulted in a major improvement of access to care with a small cost increase. The issue of pain control during examination with tele-expertise should be further addressed.
在法国，二级保健医院难以遵守早产儿视网膜病变（ROP）筛查指南。我们的目的是评估在没有现场眼科医生的新生儿重症监护病房中实施远程专家咨询方案对 ROP 筛查的有效性和效果。我们评估了由巴黎地区卫生局资助的远程专家咨询方案在巴黎地区二级保健中心综合医院（CHSF）中的影响，该医院以前没有现场眼科医生。我们进行了一项观察性、对照前后研究，对照组为有现场眼科医生的大学三级保健中心（Port-Royal）。两个时期的招募和数据收集均于 2012 年 1 月 1 日至 2012 年 12 月 31 日和 2014 年 1 月 1 日至 2015 年 3 月 31 日进行。主要终点是筛查指南的遵守率，次要终点包括疼痛评分和成本。在两个时期，CHSF 共招募了 351 名婴儿。远程专家咨询的实施使符合指南的检查比例绝对增加了 57.3%（“之前”时期为 3.8%，“之后”时期为 61.1%，p<0.001）。与对照组相比，适当筛查的婴儿比例有所提高（57.5%比 43.1%，p=0.002）；检查期间新生儿急性疼痛评分量表的中位数疼痛评分显著更高（中位数评分 5.5/10，范围[2.5-5.7]比 2.0/10，范围[1.0-3.1]，p=0.002）。对照组的筛查率保持不变。远程专家咨询组每次检查的平均费用从“之前”时期的 337 欧元增加到“之后”时期的 353 欧元。CHSF 医疗中心实施 ROP 筛查远程专家咨询极大地改善了获得护理的机会，同时成本略有增加。应进一步解决远程专家咨询检查期间的疼痛控制问题。
