A Mobile Phone Informational Reminder to Improve Eye Care Adherence Among Diabetic Patients in Rural China: A Randomized Controlled Trial.

PURPOSE: To determine whether short message service (SMS) reminders improve adherence to scheduled ocular examinations among patients with diabetes in rural China. DESIGN: Randomized controlled trial. METHODS: This study enrolled consecutive patients with diabetes scheduled for eye examinations at 5 hospitals in low-income areas of Guangdong, China from March 1, 2015 to May 31, 2016. Participants were randomized (1:1) to receive automated SMS reminders containing information about diabetic retinopathy (DR) 1 week and 3 days prior to scheduled eye appointments (Intervention) or to appointments without reminders (Control). Regression models following intention-to-treat principles were used to estimate the association between the main outcome (attendance within ± 1 week of scheduled visit) and membership in the Intervention group, with and without adjustment for other potential predictors of follow-up. Secondary outcomes included change in DR knowledge score (1, worst; 5, best) and endline satisfaction with care (3, worst; 15, best). RESULTS: Among 233 patients, 119 (51.1%) were randomized to Intervention (age 59.7 ± 11.3 years, 52.1% men) and 114 (48.9%) to Control (58.7 ± 9.50 years, 49.1% men). All participants provided data for the main study outcome. Attendance at scheduled appointments for the Intervention group (51/119, [42.9%]) was significantly higher than for Controls (16/114, [14.0%], between-group difference 28.8% [95% confidence interval (CI) 17.9%, 39.8%], P < .001). Factors associated with attendance in multiple regression models included Intervention group membership (Relative Risk [RR] 3.04, 95% CI, 1.73-5.33, P < .001) and baseline DR knowledge (RR 1.47, 95% CI 1.21-1.78, P < .001). Improvement in Satisfaction (mean difference 1.08, 95% CI 0.70-1.46, P < .001) and DR knowledge (mean difference 1.30, 95% CI 0.96-1.63, P < .001) were significantly higher for the Intervention group. Total cost of the intervention was US$5.40/person. CONCLUSION: Low-cost SMS informational reminders significantly improved adherence to, knowledge about, and satisfaction with care. Additional interventions are needed to further improve adherence.

Content Design and System Implementation of a Teleophthalmology System for Eye Disease Diagnosis and Treatment and Its Preliminary Practice in Guangdong, China.

BACKGROUND: We have developed a new telemedicine system for comprehensive eye examination, diabetic retinopathy (DR) screening, and eye disease diagnosis and treatment. The novel points of the system include a tablet application for facilitating doctor's examination and diagnosis process, a comprehensive eye examination component, and integrated treatment planning and recording. METHODS: The system provided a new service model through one ophthalmological center linking with multiple remote and rural hospitals for eye care in Guangdong province, China. RESULTS: The early stage of the project study also undertook the responsibility of educations for remote-area doctors and image graders for DR grading and glaucoma grading and research on the effectiveness of short message service (SMS) reminder for patient revisit. Some other research, such as the comparison of the accuracy of graders' DR grading with the gold standard, and doctor's tentative diagnosis with final diagnosis and related statistical information, has been implemented in the system. In the preliminary practice, we summarized the outcomes related to presenting system performance and made an initial analysis. CONCLUSION: From the practice, the project has shown the telemedicine system and associated contents have satisfied our initial goal and demonstrated their effectiveness and efficiency.