Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Health Innovation Program, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
BMJ Open. 2019 Feb 18;9(2):e022594. doi: 10.1136/bmjopen-2018-022594.
Teleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. We sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use.
We conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use. The Chronic Care Model was used as a framework for the development of the interview guide and for categorising implementation strategies to increase teleophthalmology use.
A rural, US multipayer primary care clinic with an established teleophthalmology programme for diabetic eye screening.
We conducted interviews with 29 participants (20 patients with diabetes and 9 PCPs).
Major patient barriers to teleophthalmology use included being unfamiliar with teleophthalmology, misconceptions about diabetic eye screening and logistical challenges. Major patient facilitators included a recommendation from the patient's PCP and factors related to convenience. Major PCP barriers to referring patients for teleophthalmology included difficulty identifying when patients are due for diabetic eye screening and being unfamiliar with teleophthalmology. Major PCP facilitators included the ease of the referral process and the communication of screening results. Based on our results, we developed a model that maps where these key patient and PCP barriers occur in the teleophthalmology referral process. Patients and PCPs also identified implementation strategies to directly address barriers and facilitators to teleophthalmology use.
Patients and PCPs have limited familiarity with teleophthalmology for diabetic eye screening. PCPs were expected to initiate teleophthalmology referrals, but reported significant difficulty identifying when patients are due for diabetic eye screening. System-based implementation strategies primarily targeting PCP barriers in conjunction with improved patient and provider education may increase teleophthalmology use in rural, US multipayer primary care clinics.
糖尿病眼病筛查远程眼科服务在美国多支付方初级保健诊所中是一种基于证据的干预措施，但利用率极低，即使设备和经过培训的人员已经就绪。我们试图确定患者和初级保健提供者（PCP）的障碍、促进因素以及增加远程眼科服务使用的策略。
我们进行了标准化的开放式、个体访谈，并使用归纳和定向内容分析对访谈记录进行了分析，以确定使用远程眼科服务的障碍和促进因素。慢性病护理模型被用作制定访谈指南和分类增加远程眼科服务使用的实施策略的框架。
美国农村多支付方初级保健诊所，设有用于糖尿病眼病筛查的远程眼科服务。
我们对 29 名参与者（20 名糖尿病患者和 9 名 PCP）进行了访谈。
患者使用远程眼科服务的主要障碍包括对远程眼科服务不熟悉、对糖尿病眼病筛查的误解以及后勤方面的挑战。患者的主要促进因素包括患者的 PCP 的推荐以及与便利性相关的因素。PCP 推荐患者进行远程眼科服务的主要障碍包括难以确定患者何时需要进行糖尿病眼病筛查以及对远程眼科服务不熟悉。PCP 的主要促进因素包括转诊流程的便利性和筛查结果的沟通。根据我们的研究结果，我们开发了一个模型，该模型描绘了这些关键的患者和 PCP 障碍在远程眼科服务转诊过程中的位置。患者和 PCP 还确定了直接解决使用远程眼科服务的障碍和促进因素的实施策略。
患者和 PCP 对糖尿病眼病筛查远程眼科服务的熟悉程度有限。PCP 预计会启动远程眼科服务转诊，但报告称难以确定患者何时需要进行糖尿病眼病筛查。以系统为基础的实施策略主要针对 PCP 障碍，同时加强患者和提供者教育，可能会增加美国农村多支付方初级保健诊所中远程眼科服务的使用。
