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A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care

AIM: To evaluate the potential of an integrated virtual medical retina clinic in secondary care for diabetic patients screened and referred by the UK National Diabetic Eye Screening Program (DESP). METHODS: This retrospective cohort study included diabetic patients referred by the DESP to either a v...

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Autores principales: Faes, Livia, Fu, Dun Jack, Huemer, Josef, Kern, Christoph, Wagner, Siegfried K., Fasolo, Sandro, Hamilton, Robin, Egan, Catherine, Balaskas, Konstantinos, Keane, Pearse A., Bachmann, Lucas M., Sim, Dawn A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596837/
https://www.ncbi.nlm.nih.gov/pubmed/33128024
http://dx.doi.org/10.1038/s41433-020-01240-z
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author Faes, Livia
Fu, Dun Jack
Huemer, Josef
Kern, Christoph
Wagner, Siegfried K.
Fasolo, Sandro
Hamilton, Robin
Egan, Catherine
Balaskas, Konstantinos
Keane, Pearse A.
Bachmann, Lucas M.
Sim, Dawn A.
author_facet Faes, Livia
Fu, Dun Jack
Huemer, Josef
Kern, Christoph
Wagner, Siegfried K.
Fasolo, Sandro
Hamilton, Robin
Egan, Catherine
Balaskas, Konstantinos
Keane, Pearse A.
Bachmann, Lucas M.
Sim, Dawn A.
author_sort Faes, Livia
collection PubMed
description AIM: To evaluate the potential of an integrated virtual medical retina clinic in secondary care for diabetic patients screened and referred by the UK National Diabetic Eye Screening Program (DESP). METHODS: This retrospective cohort study included diabetic patients referred by the DESP to either a virtual or a traditional doctor’s appointment (face-to-face, F2F) at the Moorfields Eye Hospital NHS Foundation Trust (London, UK) between January 2015 and December 2018. The primary outcome was the proportion of patients that qualified for a virtual-clinic appointment according to hospital guidance. Secondary outcomes included the rate of attendance, mean time from DESP referral to initial hospital appointment, mean time-to-discharge and -to-treatment of either panretinal photocoagulation or intravitreal injection of anti-vascular endothelial growth factor. RESULTS: We included 12,563 patients in this study. While 8833 patients (70.7%) would have qualified for a virtual appointment according to local triage guidance, only 2306 (18.4%) were referred to a virtual consultation due to capacity constraints. For routine referrals, mean time to the first hospital appointment was 66.9 days with a standard deviation of ±35.9 and 80.9 ± 44.4 days for a virtual and a F2F consultation, respectively. The mean time from referral to discharge to community was 71.7 ± 30.8 and 86.3 ± 37.0 days for a virtual and a F2F consultation, respectively. We did not observe a statistically significant difference in the mean time-to-treatment in the sub-cohort that required intravitreal therapy for maculopathy (virtual clinics: 220.7 ± 84.8; F2F: 178.0 days ± 80.7; p value > 0.05). Moreover, we observed a non-inferior attendance rate in virtual as compared to F2F clinics. CONCLUSION: A significant proportion of diabetic patients referred to a F2F clinic could initially be managed in a virtual clinic. Increasing the adoption of virtual clinics in the management of diabetic patients that do not need long-term management or monitoring in secondary services may help alleviate service demands without diminishing quality of clinical care. Collectively, our analyses suggest that virtual consultations are a faster and clinically appropriate alternative for a substantial proportion of diabetic patients.
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spelling pubmed-75968372020-10-30 A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care Faes, Livia Fu, Dun Jack Huemer, Josef Kern, Christoph Wagner, Siegfried K. Fasolo, Sandro Hamilton, Robin Egan, Catherine Balaskas, Konstantinos Keane, Pearse A. Bachmann, Lucas M. Sim, Dawn A. Eye (Lond) Article AIM: To evaluate the potential of an integrated virtual medical retina clinic in secondary care for diabetic patients screened and referred by the UK National Diabetic Eye Screening Program (DESP). METHODS: This retrospective cohort study included diabetic patients referred by the DESP to either a virtual or a traditional doctor’s appointment (face-to-face, F2F) at the Moorfields Eye Hospital NHS Foundation Trust (London, UK) between January 2015 and December 2018. The primary outcome was the proportion of patients that qualified for a virtual-clinic appointment according to hospital guidance. Secondary outcomes included the rate of attendance, mean time from DESP referral to initial hospital appointment, mean time-to-discharge and -to-treatment of either panretinal photocoagulation or intravitreal injection of anti-vascular endothelial growth factor. RESULTS: We included 12,563 patients in this study. While 8833 patients (70.7%) would have qualified for a virtual appointment according to local triage guidance, only 2306 (18.4%) were referred to a virtual consultation due to capacity constraints. For routine referrals, mean time to the first hospital appointment was 66.9 days with a standard deviation of ±35.9 and 80.9 ± 44.4 days for a virtual and a F2F consultation, respectively. The mean time from referral to discharge to community was 71.7 ± 30.8 and 86.3 ± 37.0 days for a virtual and a F2F consultation, respectively. We did not observe a statistically significant difference in the mean time-to-treatment in the sub-cohort that required intravitreal therapy for maculopathy (virtual clinics: 220.7 ± 84.8; F2F: 178.0 days ± 80.7; p value > 0.05). Moreover, we observed a non-inferior attendance rate in virtual as compared to F2F clinics. CONCLUSION: A significant proportion of diabetic patients referred to a F2F clinic could initially be managed in a virtual clinic. Increasing the adoption of virtual clinics in the management of diabetic patients that do not need long-term management or monitoring in secondary services may help alleviate service demands without diminishing quality of clinical care. Collectively, our analyses suggest that virtual consultations are a faster and clinically appropriate alternative for a substantial proportion of diabetic patients. Nature Publishing Group UK 2020-10-30 2021-08 /pmc/articles/PMC7596837/ /pubmed/33128024 http://dx.doi.org/10.1038/s41433-020-01240-z Text en © The Author(s), under exclusive licence to The Royal College of Ophthalmologists 2020
spellingShingle Article
Faes, Livia
Fu, Dun Jack
Huemer, Josef
Kern, Christoph
Wagner, Siegfried K.
Fasolo, Sandro
Hamilton, Robin
Egan, Catherine
Balaskas, Konstantinos
Keane, Pearse A.
Bachmann, Lucas M.
Sim, Dawn A.
A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title_full A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title_fullStr A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title_full_unstemmed A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title_short A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
title_sort virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596837/
https://www.ncbi.nlm.nih.gov/pubmed/33128024
http://dx.doi.org/10.1038/s41433-020-01240-z
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