Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care.
Telemed J E Health
; 27(9): 1021-1028, 2021 09.
Article
en En
| MEDLINE
| ID: mdl-33216697
ABSTRACT
Background:
Teleophthalmology is a validated method for diabetic eye screening that is underutilized in U.S. primary care clinics. Even when made available to patients, its long-term effectiveness for increasing screening rates is often limited.Introduction:
We hypothesized that a stakeholder-based implementation program could increase teleophthalmology use and sustain improvements in diabetic eye screening. Materials andMethods:
We used the NIATx Model to test a stakeholder-based teleophthalmology implementation program, I-SITE at one primary care clinic (Main) and compared teleophthalmology use and diabetic eye screening rates with those of other primary care clinics (Outreach) within a U.S. multipayer health system where teleophthalmology was underutilized.Results:
Teleophthalmology use increased post-I-SITE implementation (odds ratio [OR] = 5.73 [p < 0.001]), and was greater at the Main than at the Outreach clinics (OR = 10.0 vs. 1.69, p < 0.001). Overall diabetic eye screening rates maintained an increase from 47.4% at baseline to 60.2% and 64.1% at 1 and 2 years post-I-SITE implementation, respectively (p < 0.001). Patients who were younger (OR = 0.98 per year of age, p = 0.02) and men (OR = 1.98, p = 0.002) were more likely to use teleophthalmology than in-person dilated eye examinations for diabetic eye screening.Discussion:
Our stakeholder-based implementation program achieved a significant increase in overall teleophthalmology use and maintained increased post-teleophthalmology diabetic eye screening rates.Conclusion:
Stakeholder-based implementation may increase the long-term reach and effectiveness of teleophthalmology to reduce vision loss from diabetes. Our approach may improve integration of telehealth interventions into primary care.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Oftalmología
/
Telemedicina
/
Diabetes Mellitus
/
Retinopatía Diabética
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
/
Screening_studies
/
Sysrev_observational_studies
Límite:
Humans
/
Male
Idioma:
En
Revista:
Telemed J E Health
Asunto de la revista:
INFORMATICA MEDICA
/
SERVICOS DE SAUDE
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos