Stanimirovic Aleksandra, Francis Troy, Cooper Reed Anna, Meerai Sonia, Sutakovic Olivera, Merritt Rebecca, Brent Michael, Rac Valeria
Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
JMIR Res Protoc. 2021 Mar 5;10(3):e23492. doi: 10.2196/23492.
By 2025, 5 million Canadians will be diagnosed with diabetes, and women from lower socioeconomic groups will likely account for most new diagnoses. Diabetic retinopathy is a primary vision complication of diabetes and a leading cause of blindness among adults, with 26% prevalence among women. Tele-retina is a branch of telemedicine that delivers eye care remotely. Screening for diabetic retinopathy has great potential to reduce the incidence of blindness, yet there is an adverse association among screening, income, and gender.
We aim to explore gender disparity in the provision of tele-retina program services for diabetic retinopathy screening in a cohort of women of low socioeconomic status (SES) receiving services in South Riverdale Community Health Centre (SRCHC) between 2014 and 2019.
Using a convergent mixed methods design, we want to understand patients', providers', administrators', and decision makers' perceptions of the facilitators and barriers associated with the implementation and adoption of tele-retina. Multivariate logistic regression will be utilized to assess the association among client characteristics, referral source, and diabetic retinopathy screening. Guided by a grounded theory approach, systematic coding of data and thematic analysis will be utilized to identify key facilitators and barriers to the implementation and adoption of tele-retina.
For the quantitative component, we anticipate a cohort of 2500 patients, and we expect to collect data on the overall patterns of tele-retina program use, including descriptions of program utilization rates (such as data on received and completed diabetic retinopathy screening referrals) along the landscape of patient populations receiving these services. For the qualitative component, we plan to interview up to 21 patients and 14 providers, administrators, and decision makers, and to conduct up to 14 hours of observations alongside review of relevant documents. The interview guide is being developed in collaboration with our patient partners. Through the use of mixed methods research, the inquiry will be approached from different perspectives. Mixed methods will guide us in combining the rich subjective insights on complex realities from qualitative inquiry with the standard generalizable data that will be generated through quantitative research. The study is under review by the University Health Network Research Ethics Board (19-5628). We expect to begin recruitment in winter 2021.
In Ontario, the screening rate for diabetic retinopathy among low income groups remains below 65%. Understanding the facilitators and barriers to diabetic retinopathy screening may be a prerequisite in the development of a successful screening program. This study is the first Ontario study to focus on diabetic retinopathy screening practices in women of low SES, with the aim to improve their health outcomes and revolutionize access to quality care.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/23492.
到2025年，将有500万加拿大人被诊断出患有糖尿病，社会经济地位较低群体的女性可能占大多数新诊断病例。糖尿病视网膜病变是糖尿病的主要视力并发症，也是成年人失明的主要原因，女性患病率为26%。远程视网膜是远程医疗的一个分支，可提供远程眼部护理。糖尿病视网膜病变筛查对于降低失明发生率具有巨大潜力，但筛查、收入和性别之间存在不良关联。
我们旨在探讨2014年至2019年期间在南河滨社区健康中心（SRCHC）接受服务的社会经济地位较低（SES）女性队列中，在提供用于糖尿病视网膜病变筛查的远程视网膜项目服务方面的性别差异。
采用收敛性混合方法设计，我们希望了解患者、提供者、管理人员和决策者对与远程视网膜实施和采用相关的促进因素和障碍的看法。将利用多变量逻辑回归来评估客户特征、转诊来源和糖尿病视网膜病变筛查之间的关联。以扎根理论方法为指导，将对数据进行系统编码和主题分析，以确定远程视网膜实施和采用的关键促进因素和障碍。
对于定量部分，我们预计有2500名患者的队列，并期望收集有关远程视网膜项目使用总体模式的数据，包括在接受这些服务的患者群体范围内的项目利用率描述（如收到和完成的糖尿病视网膜病变筛查转诊数据）。对于定性部分，我们计划采访多达21名患者以及14名提供者、管理人员和决策者，并进行多达14小时的观察以及相关文件审查。访谈指南正在与我们的患者合作伙伴合作制定。通过使用混合方法研究，将从不同角度进行调查。混合方法将指导我们将定性调查中关于复杂现实的丰富主观见解与通过定量研究产生的标准可推广数据相结合。该研究正在接受大学健康网络研究伦理委员会的审查（19 - 5628）。我们预计在2021年冬季开始招募。
在安大略省，低收入群体中糖尿病视网膜病变的筛查率仍低于65%。了解糖尿病视网膜病变筛查的促进因素和障碍可能是制定成功筛查项目的先决条件。本研究是安大略省第一项关注社会经济地位较低女性糖尿病视网膜病变筛查实践的研究，旨在改善她们的健康结果并彻底改变获得优质护理的途径。
国际注册报告标识符（IRRID）：PRR1 - 10.2196/23492。
