美国远程医疗糖尿病视网膜病变筛查的效果：系统评价和荟萃分析方案。

Effectiveness of telemedicine diabetic retinopathy screening in the USA: a protocol for systematic review and meta-analysis.

机构信息

Department of Ophthalmology and Visual Science, University of Kentucky, Lexington, KY, USA.

Medical Center Library, University of Kentucky, Lexington, KY, USA.

出版信息

Syst Rev. 2023 Mar 16;12(1):48. doi: 10.1186/s13643-023-02201-9.

DOI:10.1186/s13643-023-02201-9

PMID:36927386

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10018958/

Abstract

BACKGROUND

Diabetic retinopathy (DR) is the leading cause of vision loss among adults in the USA. Vision loss associated with diabetic retinopathy can be prevented with timely ophthalmologic care, and therefore, it is recommended that individuals with diabetes have annual retinal examinations. There is limited evidence on whether using telemedicine to screen for DR in primary care clinics in the USA effectively leads to increased DR screening rates. The objective of this systematic review is to collate evidence from existing studies to investigate the effectiveness of telemedicine DR screening (TDRS) in primary care clinics on DR screening rates.

METHODS

Relevant studies will be identified through searching MEDLINE/PubMed interface, Scopus, and Web of Science from their inception until November 2021, as well as searching reference lists of included studies and previous related review articles or systematic reviews. There will be no restrictions on study design. Eligible studies will include subjects with either type 1 or type 2 diabetes, will evaluate telemedicine technology for screening of DR, will have been conducted in the USA, and will report DR screening rates or data necessary for calculating such rates. Two reviewers will screen search results independently. Risk-of-bias assessment and data extraction will be carried out by two reviewers. The version 2 of the Cochrane risk-of-bias tool (RoB 2) and the Newcastle-Ottawa scale (NOS) tool will be used to assess the quality and validity of individual studies. If feasible, we will conduct random-effects meta-analysis where appropriate. If possible, we will conduct subgroup analyses to explore potential heterogeneity sources (setting, socio-economic status, age, ethnicity, study design, outcomes). We will disseminate the findings through publications and relevant networks.

DISCUSSION

This protocol outlines the methods for systematic review and synthesis of evidence of TDRS and its effect on DR screening rates. The results will be of interest to policy makers and program managers tasked with designing and implementing evidence-based services to prevent and manage diabetes and its complications in similar settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021231067.

摘要

背景

糖尿病视网膜病变（DR）是美国成年人视力丧失的主要原因。通过及时的眼科护理，可以预防与糖尿病视网膜病变相关的视力丧失，因此，建议糖尿病患者每年进行视网膜检查。在美国的初级保健诊所中，使用远程医疗筛查 DR 是否能有效提高 DR 筛查率，这方面的证据有限。本系统评价的目的是整理现有研究的证据，以调查美国初级保健诊所远程医疗糖尿病视网膜病变筛查（TDRS）在提高 DR 筛查率方面的有效性。

方法

将通过搜索 MEDLINE/PubMed 界面、Scopus 和 Web of Science 从其成立到 2021 年 11 月，以及搜索纳入研究的参考文献列表和以前的相关综述文章或系统评价，来确定相关研究。研究设计不受限制。合格的研究将包括 1 型或 2 型糖尿病患者，将评估用于 DR 筛查的远程医疗技术，将在美国进行，并报告 DR 筛查率或计算此类率所需的数据。两名评审员将独立筛选搜索结果。风险偏倚评估和数据提取将由两名评审员进行。将使用 Cochrane 风险偏倚工具（RoB 2）和纽卡斯尔-渥太华量表（NOS）工具的第 2 版评估单个研究的质量和有效性。如果可行，我们将在适当情况下进行随机效应荟萃分析。如果可能，我们将进行亚组分析，以探索潜在的异质性来源（设置、社会经济地位、年龄、种族、研究设计、结果）。我们将通过出版物和相关网络传播研究结果。