Polat Julia K, Hughes Emily L, Brown Eric N, Conner Ian P
Ophthalmology Division, Pittsburgh Veterans Affairs Medical Center-University Drive, Pittsburgh, Pennsylvania; Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ophthalmol Glaucoma. 2021 Nov-Dec;4(6):632-637. doi: 10.1016/j.ogla.2021.03.016. Epub 2021 Apr 9.
To evaluate the safety, reliability, and efficacy of telemedicine in delivering tertiary subspecialty glaucoma care (herein referred to as teleglaucoma) to the veteran patient population.
Prospective case series.
Twenty patients being referred for glaucoma subspecialist opinion participated in the pilot safety study. One hundred eighteen patients participated in the secondary study of the acceptability and service efficacy of teleglaucoma.
In the pilot study, safety was assessed by determining interobserver and intraobserver consistency (Krippendorff's α). This compared an in-person assessment by a glaucoma subspecialist with the remote assessment of 2 other glaucoma subspecialists (electronic health record alone reviewed). In the secondary study, teleglaucoma was implemented whereby testing and eye examination were carried out remotely by an optometrist or comprehensive ophthalmologist, and the clinical decision was made by the glaucoma subspecialist on review of the electronic health record alone.
In the pilot study, interobserver and intraobserver consistency in making a diagnosis and treatment plan (acceptable, ≥ 0.80 Krippendorff's α). In the secondary study, patient satisfaction measured by survey, wait time for teleglaucoma opinion versus wait time for in-person opinion, and time spent on teleglaucoma consultations.
Interobserver and intraobserver consistency showed an α of 0.86 and 0.92, respectively, for diagnosis, and 0.86 and 0.85, respectively, for treatment plan. In the secondary study, patient satisfaction was 4.55 of 5.00 (5 = maximum satisfaction; range, 3.28-4.93). Improved consultation lead time was demonstrated, with the median time for a doctor to respond to an electronic consultation being 3 days, versus 43 days for an in-person visit. Teleglaucoma also demonstrated positive benefits to the health care system by reducing the time doctors spent reviewing each patient's case (history, examination findings, imaging results, visual fields; 19 minutes for teleglaucoma consultation vs. 31 minutes for in-person evaluation).
Decisions regarding diagnoses and treatment plans between in-person consultation and the teleglaucoma program showed high reliability. Patient satisfaction was high. Additional benefits were observed in wait time for subspecialty glaucoma opinion, efficient allocation of the doctor's time, and fiscal benefit to the health care system.
评估远程医疗为退伍军人患者群体提供三级专科青光眼护理（以下简称远程青光眼护理）的安全性、可靠性和有效性。
前瞻性病例系列研究。
20名被转诊以获取青光眼专科意见的患者参与了安全性预试验研究。118名患者参与了远程青光眼护理可接受性和服务有效性的二次研究。
在预试验研究中，通过确定观察者间和观察者内一致性（克里彭多夫α系数）来评估安全性。这将青光眼专科医生的现场评估与另外两名青光眼专科医生的远程评估（仅审查电子健康记录）进行了比较。在二次研究中，实施了远程青光眼护理，由验光师或综合眼科医生进行远程测试和眼部检查，青光眼专科医生仅通过审查电子健康记录做出临床决策。
在预试验研究中，做出诊断和治疗计划时的观察者间和观察者内一致性（可接受，克里彭多夫α系数≥0.80）。在二次研究中，通过调查衡量患者满意度、远程青光眼护理意见的等待时间与现场意见的等待时间，以及远程青光眼护理咨询所花费的时间。
在诊断方面，观察者间和观察者内一致性的α系数分别为0.86和0.92，治疗计划方面分别为0.86和0.85。在二次研究中，患者满意度为5.00分中的4.55分（5分为最高满意度；范围为3.28 - 4.93分）。咨询周转时间有所改善，医生回复电子咨询的中位时间为3天，而现场就诊为43天。远程青光眼护理还通过减少医生审查每位患者病例（病史、检查结果、影像结果、视野）所花费的时间，对医疗保健系统显示出积极益处（远程青光眼护理咨询为19分钟，现场评估为31分钟）。
现场咨询与远程青光眼护理计划之间在诊断和治疗计划方面的决策显示出高度可靠性。患者满意度较高。在获得青光眼专科意见的等待时间、医生时间的有效分配以及医疗保健系统的经济效益方面观察到了额外益处。
