Ramchandran Rajeev S, Yousefi-Nooraie Reza, Dadgostar Porooshat, Yilmaz Sule, Basant Jesica, Dozier Ann M
Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, United States.
Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.
JMIR Diabetes. 2022 Mar 30;7(1):e32162. doi: 10.2196/32162.
The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption.
This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science.
This qualitative study in 3 urban, low-income, largely racial and ethnic minority-serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research.
Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability.
Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.
基于存储转发摄像头的眼部评估，即远程眼科，是识别糖尿病视网膜病变（美国失明的主要原因）的有效方法，但采用率一直很低。了解积极采用、运行和维持此类项目的人员在实施远程眼科项目时所面临的障碍和促进因素，对于广泛采用该项目至关重要。
本研究旨在通过实施科学，了解在基层医疗诊所引入远程眼科以改善糖尿病患者获得诊断性眼部护理机会的重要因素。
在纽约罗切斯特的3家城市低收入、主要服务于种族和族裔少数群体的安全网基层医疗诊所进行的这项定性研究，通过基于实用、稳健实施与可持续性模型以及实施研究综合框架提出的问题，对护士和医生进行了关于实施远程眼科项目的访谈。
在其诊所实施该项目的基层医疗护士认为工作负担增加和自我效能感不足是障碍。受访者认为需要通过由倡导者和超级用户进行在职培训和同伴培训，对护士、医生和行政人员进行持续的远程眼科流程培训。促进因素包括患者感知到的便利性以及该项目被认为具有的教育优势，因为它为医疗服务提供者提供了与患者讨论眼部护理重要性的机会。由于护理协调方面的挑战，突出了在向眼科转诊和跟踪转诊方面的担忧。许多工作人员对该项目的财务方面（如患者保险范围和医疗服务提供者报销）不清楚，这影响了采用率和可持续性。
简化流程和工作流程、培训和分配足够的工作人员、有效地协调基层医疗和眼科护理以改善随访，以及确保财务可行性，都有助于简化远程眼科的采用。
