Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
BMJ Health Care Inform. 2021 Jan;28(1). doi: 10.1136/bmjhci-2020-100287.
To assess the agreement in diagnosis and management plans reached between clinicians reviewing eyelid lesions remotely and in face-to-face clinics.
In this single-centre observational case series, data were prospectively collected on 50 consecutive adults referred with eyelid lesions suitable to be seen by a nurse. A proforma was completed to gather salient information. A nurse specialist saw patients in face-to-face clinics and collected information using the proforma, devising a diagnosis and management plan. Photographs of the eyelid lesions were taken by a medical photographer. A subsequent remote review was completed by an oculoplastic consultant using the proforma information and photographs in the absence of the patient. The diagnosis and management plan constructed by the nurse specialist were compared with those reached by the consultant.
Complete data were available for 44 consecutive cases. There was an overall 91% agreement (40 cases out of 44) between the diagnoses reached by the nurse specialist, and the remote reviewer; kappa coefficient 0.88 (95% CI 0.76 to 0.99). There was an overall 82% agreement (36 out of 44 cases) in the management plans devised by the nurse-led clinic and remote reviewer; kappa coefficient 0.74 (95% CI 0.58 to 0.90). The average time taken for a remote reviewer to reach a diagnosis and management plan was 1 min and 20 s.
This study evaluated the feasibility of assessing eyelid lesions using asynchronous telemedicine. There was overall a high rate of concordance in the diagnosis reached, and management devised between the clinic and remote review.
评估远程和面对面临床医生对眼睑病变的诊断和治疗计划达成的一致性。
在这项单中心观察性病例系列研究中，前瞻性收集了 50 例连续成年患者的眼睑病变数据，这些病变适合由护士进行检查。填写表格以收集重要信息。一名护士专家在面对面的诊所中对患者进行检查，并使用表格收集信息，制定诊断和治疗计划。由一名医学摄影师拍摄眼睑病变的照片。随后，一名眼整形顾问在没有患者的情况下使用表格信息和照片进行远程审查。比较护士专家制定的诊断和治疗计划与顾问制定的计划。
连续 44 例患者中有完整数据。护士专家和远程审查员之间的诊断总体上有 91%的一致性（44 例中有 40 例）；kappa 系数为 0.88（95%CI 0.76 至 0.99）。护士主导的诊所和远程审查员制定的管理计划总体上有 82%的一致性（44 例中有 36 例）；kappa 系数为 0.74（95%CI 0.58 至 0.90）。远程审查员制定诊断和治疗计划的平均时间为 1 分 20 秒。
本研究评估了使用异步远程医疗评估眼睑病变的可行性。在诊所和远程审查之间，诊断和管理计划的一致性总体上很高。
