دورية أكاديمية
Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network.
| العنوان: | Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network. |
|---|---|
| المؤلفون: | Jani PD; Department of Ophthalmology, University of North Carolina at Chapel Hill2Department of Family Medicine, University of North Carolina at Chapel Hill., Forbes L; Department of Ophthalmology, University of North Carolina at Chapel Hill., Choudhury A; Department of Biostatistics, University of North Carolina at Chapel Hill., Preisser JS; Department of Biostatistics, University of North Carolina at Chapel Hill., Viera AJ; Department of Family Medicine, University of North Carolina at Chapel Hill., Garg S; Department of Ophthalmology, University of North Carolina at Chapel Hill. |
| المصدر: | JAMA ophthalmology [JAMA Ophthalmol] 2017 Jul 01; Vol. 135 (7), pp. 706-714. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589539 Publication Model: Print Cited Medium: Internet ISSN: 2168-6173 (Electronic) Linking ISSN: 21686165 NLM ISO Abbreviation: JAMA Ophthalmol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Diagnostic Techniques, Ophthalmological* , Referral and Consultation*, Diabetic Retinopathy/*diagnosis , Mass Screening/*methods , Ophthalmology/*methods , Telemedicine/*methods, Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; North Carolina/epidemiology ; Retrospective Studies ; Rural Population |
| مستخلص: | Importance: Retinal telescreening for evaluation of diabetic retinopathy (DR) in the primary care setting may be useful in reaching rural and underserved patients. Objectives: To evaluate telemedicine retinal screenings for patients with type 1 or 2 diabetes and identify factors for ophthalmology referral in the North Carolina Diabetic Retinopathy Telemedicine Network. Design, Setting, and Participants: A preimplementation and postimplementation evaluation was conducted from January 6, 2014, to November 1, 2015, at 5 primary care clinics serving rural and underserved populations in North Carolina among 1787 adult patients with type 1 or 2 diabetes who received primary care at the clinics and obtained retinal telescreening to determine the presence and severity of DR. A total of 1661 patients with complete data were included in the statistical analysis. Intervention: Nonmydriatic fundus photography with remote interpretation by an expert. Main Outcomes and Measures: Number of patients recruited, level of detected DR, change in rates of screening, rate of ophthalmology referral, percentage of completed referrals, and patient characteristics associated with varying levels of DR. Results: Of the 1661 patients (1041 women and 620 men; mean [SD] age, 55.4 [12.7] years), 1323 patients (79.7%) had no DR, 183 patients (11.0%) had DR without a need for an ophthalmology referral, and 155 patients (9.3%) had DR with a need for an ophthalmology referral. The mean rate of screening for DR before implementation of the program was 25.6% (1512 of 5905), which increased to 40.4% (1884 of 4664) after implementation. A total of 93 referred patients (60.0%) completed an ophthalmology referral visit within the study period. Older patients (odds ratio [OR], 1.28; 95% CI, 1.11-1.48) and African American patients (OR, 1.84; 95% CI, 1.24-2.73) or other racial/ethnic minorities (OR, 2.19; 95% CI, 1.16-4.11) had greater odds of requiring an ophthalmology referral compared with white and/or younger patients. Patients with higher hemoglobin A1c levels (OR, 1.19 per unit change; 95% CI, 1.13-1.25 per unit change) and longer duration of diabetes (OR, 1.76 per decade; 95% CI, 1.53-2.02 per decade) had greater odds of DR requiring an ophthalmology referral. History of stroke (OR, 1.65; 95% CI, 1.10-2.48) and kidney disease (OR, 1.59; 95% CI, 1.10-2.31) were strongly associated with DR and ophthalmology referral. Conclusions and Relevance: When implemented in the primary care setting, retinal telescreening increased the rate of evaluation for DR for patients in rural and underserved settings. This strategy may also increase access to care for minorities and patients with DR requiring treatment. |
| التعليقات: | Comment in: JAMA Ophthalmol. 2018 May 1;136(5):599. (PMID: 29677239) Comment in: JAMA Ophthalmol. 2018 May 1;136(5):599-600. (PMID: 29677241) |
| References: | Ophthalmology. 2003 Oct;110(10):1952-9. (PMID: 14522771) Ophthalmology. 1991 May;98(5 Suppl):741-56. (PMID: 2062510) N C Med J. 2011 Sep-Oct;72(5):360-4. (PMID: 22416511) Diabetes Care. 2005 Feb;28(2):318-22. (PMID: 15677786) Ophthalmology. 1998 Oct;105(10):1801-15. (PMID: 9787347) Arch Ophthalmol. 2005 Mar;123(3):387-91. (PMID: 15767483) Ophthalmology. 2003 Sep;110(9):1677-82. (PMID: 13129861) Diabetes Metab. 2008 Jun;34(3):227-34. (PMID: 18468470) Telemed J E Health. 2016 Mar;22(3):198-208. (PMID: 26308281) Diabetes Care. 2017 Mar;40(3):412-418. (PMID: 28223445) Telemed J E Health. 2014 Feb;20(2):102-8. (PMID: 24219153) JAMA. 1993 Oct 13;270(14):1714-8. (PMID: 8411502) Arch Intern Med. 2012 Nov 26;172(21):1677-8. (PMID: 23026969) Ophthalmology. 1981 Jul;88(7):583-600. (PMID: 7196564) J Diabetes Sci Technol. 2008 Jan;2(1):33-9. (PMID: 19885175) Middle East Afr J Ophthalmol. 2013 Jan-Mar;20(1):56-60. (PMID: 23580853) Diabetes Metab. 2009 Jun;35(3):228-32. (PMID: 19349202) Ophthalmology. 2012 Sep;119(9):1725-30. (PMID: 22537615) N Engl J Med. 1999 Aug 26;341(9):667-78. (PMID: 10460819) JAMA Ophthalmol. 2015 May;133(5):518-25. (PMID: 25741666) Telemed J E Health. 2011 Oct;17(8):627-34. (PMID: 21819244) Arch Ophthalmol. 1990 Jul;108(7):958-64. (PMID: 2196036) Arch Ophthalmol. 2008 Dec;126(12):1740-7. (PMID: 19064858) Ophthalmology. 2006 Aug;113(8):1372-7. (PMID: 16769120) Ann Intern Med. 2004 Aug 17;141(4):272-81. (PMID: 15313743) N Engl J Med. 1993 Sep 30;329(14 ):977-86. (PMID: 8366922) Diabetes Care. 1992 Dec;15(12):1875-91. (PMID: 1464243) Ophthalmology. 2009 Mar;116(3):497-503. (PMID: 19167079) Telemed J E Health. 2013 Dec;19(12):942-8. (PMID: 24102102) Ophthalmology. 2016 Jun;123(6):1351-9. (PMID: 26935357) Telemed J E Health. 2005 Dec;11(6):641-51. (PMID: 16430383) J Health Care Poor Underserved. 2011 Aug;22(3):804-16. (PMID: 21841280) Clin Ophthalmol. 2016 Feb 10;10:285-95. (PMID: 26929592) Ophthalmology. 1991 May;98(5 Suppl):766-85. (PMID: 2062512) J Telemed Telecare. 2006;12(3):159-60. (PMID: 16638238) J Telemed Telecare. 2003;9(2):109-13. (PMID: 12699582) Diabetes Care. 2014;37(5):1321-8. (PMID: 24574354) JAMA. 2015 Nov 24;314(20):2137-46. (PMID: 26565927) JAMA Ophthalmol. 2015 Feb;133(2):174-81. (PMID: 25393129) Phys Ther. 2008 Nov;88(11):1254-64. (PMID: 18801858) |
| تواريخ الأحداث: | Date Created: 20170519 Date Completed: 20170809 Latest Revision: 20220408 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC5710198 |
| DOI: | 10.1001/jamaophthalmol.2017.1150 |
| PMID: | 28520833 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6173 |
|---|---|
| DOI: | 10.1001/jamaophthalmol.2017.1150 |