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

Abstract

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.

The Effect on Patients’ Visual Acuity and Grade, Secondary to Non-Attendance at Treatment Centers, Post Referral from Diabetic RetinaScreen Ireland

“… 14 Faes et al reported a DNA rate of 32% and 28% from DRS to HES, for face to face, and virtual consultations, respectively. 15 Keenum et al found that 24% of patients referred with STDR had no record of attendance at the ophthalmology service two years after initial referral. 16 …”

Digital Advancements in Retinal Models of Care in the Post–COVID-19 Lockdown Era

“…One of the major limitations of telemedicine in retina is the need to obtain anatomical evaluation of the macular and retina to make treatment decisions. Prepandemic, various institutions have already developed imaging-based “virtual” clinics, with asynchronous review of imaging results and telemedicine-based communication of findings to patients 7–9. These virtual imaging clinics often deploy optical coherence tomography (OCT) with standard or ultra-widefield fundus photography to provide the imaging input required to manage diseases from diabetic retinopathy and macular edema to age-related macular degeneration (AMD).…”

“…Prepandemic, various institutions have already developed imaging-based "virtual" clinics, with asynchronous review of imaging results and telemedicine-based communication of findings to patients. [7][8][9] These virtual imaging clinics often deploy optical coherence tomography (OCT) with standard or ultra-widefield fundus photography to provide the imaging input required to manage diseases from diabetic retinopathy and macular edema to agerelated macular degeneration (AMD). Although these imaging clinics still require the patient to travel out of their homes for imaging, it has the potential to reduce crowding and waiting times in hospitals thereby improving social distancing and reducing the risk of infection.…”

Transforming ophthalmology in the digital century—new care models with added value for patients

“…Image analysis can also be performed by specially trained non-medical professionals, supported by automated image analysis outside the hospital in a reading centre. Reading centres and other specialists with the help of retina experts are the ones who currently develop AI based systems which should be able to decide if there is disease activity and make treatment suggestions, e.g., treatment intervals [ 10 , 14 , 21 , 36 – 38 ]. In the UK, a national system organized in this way to detect diabetics with retinal diseases requiring treatment has led to a marked reduction in legal blindness and an improvement in care without the need to increase medical staff [ 19 ].…”