Carrasco Solís Rafael, Rodríguez Griñolo Mª Rosario, Ponte Zúñiga Beatriz, Mataix Albert Beatriz, Lledó de Villar María Leticia, González Troncoso María José, Martínez de Pablos Rocío, Rodríguez de La Rúa Franch Enrique
Universidad de Sevilla, Spain.
Universidad Pablo de Olavide, Spain.
Inquiry. 2025 Jan-Dec;62:469580251367231. doi: 10.1177/00469580251367231. Epub 2025 Aug 27.
The triage classification and diagnosis of eye diseases in primary care patients through teleophthalmology were performed by ophthalmologists, optometrists, and family physicians. The agreement in and diagnosis between observers, as well as the quality of referrals from primary care to ophthalmology, were evaluated. Study to compare methods using a non-inferiority method approach. The sample comprised 220 patients with suspected ocular problems evaluated by family physicians. These patients were examined by an optometrist ) using a Visionix VX650 multi-diagnostic platform. The optometrist provided a suspected diagnosis and a referral. The tests were forwarded electronically to an ophthalmologist (observer 2), who provided a diagnosis and referral. Subsequently, they were reviewed in person by an ophthalmologist (observer 3) who provided a diagnosis and referral. The observers worked independently and at different times, without knowledge of each other's evaluations, ensuring the objectivity of the analysis. We analyzed interobserver agreement in and diagnosis using the Kappa index. The of patients by teleophthalmology coincides with that of in-person ophthalmology in 91.2% of the cases (Kappa = 0.819). The optician's coincided with in-person ophthalmology in 91.3% (Kappa = 0.858) and with teleophthalmology in 92.3% (Kappa = 0.851). The diagnostic categories, teleophthalmology and in-person ophthalmology coincided in 84.61% of the cases (Kappa = 0.80). The optician coincided with in-person ophthalmology in 90.65% (Kappa = 0.88) and with teleophthalmology in 90.9% of the diagnoses (Kappa = 0.87). There was a very high level interobserver agreement for both and diagnostic categories. This validates our teleophthalmology approach, conducted in a primary care setting by optometrists, family physicians, and ophthalmologists, for an effective triage classification of patients referred to ophthalmology services. This t also accurately categorizes patients based on their conditions, optimizing resources, reducing waiting times and waiting lists.
眼科医生、验光师和家庭医生通过远程眼科对初级保健患者的眼病进行分诊分类和诊断。评估了观察者之间在诊断方面的一致性，以及从初级保健转诊到眼科的质量。采用非劣效性方法比较研究方法。样本包括220名由家庭医生评估的疑似眼部问题患者。这些患者由一名验光师使用Visionix VX650多诊断平台进行检查。验光师提供疑似诊断和转诊建议。检查结果通过电子方式转发给一名眼科医生（观察者2），后者提供诊断和转诊建议。随后，由一名眼科医生（观察者3）亲自进行复查并提供诊断和转诊建议。观察者独立工作且时间不同，彼此不知道对方的评估结果，以确保分析的客观性。我们使用Kappa指数分析观察者之间在诊断方面的一致性。在91.2%的病例中，远程眼科对患者的诊断与面对面眼科诊断一致（Kappa = 0.819）。验光师的诊断与面对面眼科诊断一致率为91.3%（Kappa = 0.858），与远程眼科诊断一致率为92.3%（Kappa = 0.851）。在84.61%的病例中，远程眼科和面对面眼科的诊断类别一致（Kappa = 0.80）。验光师与面对面眼科诊断一致率为90.65%（Kappa = 0.88），与远程眼科诊断一致率为90.9%（Kappa = 0.87）。在诊断和诊断类别方面，观察者之间存在非常高的一致性。这验证了我们在初级保健环境中由验光师、家庭医生和眼科医生进行的远程眼科方法，可对转诊至眼科服务的患者进行有效的分诊分类。这也能根据患者病情准确分类，优化资源，减少等待时间和等候名单。
