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Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network.
JAMA Ophthalmol. 2017 07 01; 135(7):706-714.JO

Abstract

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.

Authors+Show Affiliations

Department of Ophthalmology, University of North Carolina at Chapel Hill2Department of Family Medicine, University of North Carolina at Chapel Hill.Department of Ophthalmology, University of North Carolina at Chapel Hill.Department of Biostatistics, University of North Carolina at Chapel Hill.Department of Biostatistics, University of North Carolina at Chapel Hill.Department of Family Medicine, University of North Carolina at Chapel Hill.Department of Ophthalmology, University of North Carolina at Chapel Hill.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28520833

Citation

Jani, Pooja D., et al. "Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network." JAMA Ophthalmology, vol. 135, no. 7, 2017, pp. 706-714.
Jani PD, Forbes L, Choudhury A, et al. Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network. JAMA Ophthalmol. 2017;135(7):706-714.
Jani, P. D., Forbes, L., Choudhury, A., Preisser, J. S., Viera, A. J., & Garg, S. (2017). Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network. JAMA Ophthalmology, 135(7), 706-714. https://doi.org/10.1001/jamaophthalmol.2017.1150
Jani PD, et al. Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network. JAMA Ophthalmol. 2017 07 1;135(7):706-714. PubMed PMID: 28520833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of Diabetic Retinal Screening and Factors for Ophthalmology Referral in a Telemedicine Network. AU - Jani,Pooja D, AU - Forbes,Lauren, AU - Choudhury,Arkopal, AU - Preisser,John S, AU - Viera,Anthony J, AU - Garg,Seema, PY - 2017/5/19/pubmed PY - 2017/8/10/medline PY - 2017/5/19/entrez SP - 706 EP - 714 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 135 IS - 7 N2 - 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. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/28520833/Evaluation_of_Diabetic_Retinal_Screening_and_Factors_for_Ophthalmology_Referral_in_a_Telemedicine_Network_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2017.1150 DB - PRIME DP - Unbound Medicine ER -