New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic

Tham, Yih Chung; Husain, Rahat; Teo, Kelvin Yi Chong; Tan, Anna; Chew, Annabel C Y; Ting, Daniel Shu Wei; Cheng, Ching Yu; Tan, Gavin Siew Wei; Wong, Tien‐Yin

doi:10.1136/bjophthalmol-2020-317683

Cited by 33 publications

(31 citation statements)

References 23 publications

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“…We flagged, for example, that the triadic hub-spoke model is somewhat labor intensive and unlikely to be scalable, whereas hub-home is limited by patients’ digital and material setup. Other models have also been described [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Wherton¹,

Greenhalgh²,

Shaw³

2021

J Med Internet Res

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Background Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.

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Section: Discussionmentioning

confidence: 99%

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Wherton¹,

Greenhalgh²,

Shaw³

2021

J Med Internet Res

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“…They can be applied to any field and pathology that needs further investigation on its mechanisms and treatment. In clinical practice, these integrative approaches will lead to new digital care models for human-centered ophthalmology including telemedicine, at-home monitoring, and AI-driven preventive and personalized care 67) .…”

Section: Discussionmentioning

confidence: 99%

Cross-hierarchical Integrative Research Network for Heterogenetic Eye Disease Toward P4 Medicine: A Narrative Review

Inomata

Sung

Nakamura

et al. 2021

Juntendo Medical Journal

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Society 5.0, a visionary human-centered societal model, fuels economic development and resolves long-standing social problems. The model establishes a technological foundation and social contract to integrate cyberspace into the physical (real) space fully. The medical infrastructure outlined by the model envisions a healthcare paradigm that revolves around preventative, lifelong patient-and population-centered care that functions seamlessly within one's daily life.In satisfying this goal, cross-hierarchical integrative data-driven biological research has received attention due to medical big data and artificial intelligence (AI) technologies, capable of highly accurate and rapid data analysis. However, the collection of big data has been a bottleneck, and the capability of AI analysis is not being utilized to its full potential. In solving this obstacle, we explore mobile health (mHealth) and multi-omics as two rich sources of medical big data. Additionally, we discuss the implications of cross-hierarchical integrative analysis that encompasses all levels of cellular function, from intracellular molecular dynamics to end-phenotypes. This is to understand ocular disease pathology and implement the pillars of P4 (predictive, personalized, preventative, participatory) medicine toward human-centered healthcare.Here, we discuss notable studies in utilizing mHealth to stratify subjective symptoms, presentations of dry eye disease, and employing multi-omics machine learning targeted at elucidating immunologic mechanisms of corneal allograft rejection and ocular inflammation. We also discuss the role of cross-hierarchical integrative data-driven research in promoting futureoriented healthcare envisioned by the Society 5.0 plan.

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“…Risk of transmission of COVID-19 is potentially high in outpatient ophthalmology practice because of close proximity, multiple tests and long visit duration [ 8 , 13 ]. A survey conducted in two tertiary eye centres in the USA revealed that fear of COVID-19 exposure was associated with a fourfold increase in the odds of loss to follow-up [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indian optometrists also shifted towards teleconsultations during the pandemic [ 25 ]. In Singapore, some eye care institutions have adopted a model where community optometrists are empowered to follow up with patients with eye diseases, thereby reducing patient traffic at tertiary eye centres [ 13 ]. Our study revealed that there were limited screenings done for Plaquenil toxicity, diabetic retinopathy and glaucoma in the Indian centre during the lockdown.…”

Section: Strategies For Future Pandemic Responsementioning

confidence: 99%

Eye Care During the COVID-19 Pandemic: A Report on Patients’ Perceptions and Experiences, an Asian Perspective

et al. 2021

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Introduction To elucidate the perceptions on eye care of patients affected by the disruption of outpatient and surgical ophthalmological services during the COVID-19 pandemic. Methods A cross-sectional questionnaire-based survey was conducted during the reopening of outpatient services at two tertiary eye care centres in Singapore and North India. Consecutive patients were recruited from general and specialist eye clinics in June 2020. Results A total of 326 patients were recruited, 200 patients from Singapore and 126 patients from New Delhi, India. The most common eye conditions were diabetic retinopathy and uveitis or ocular inflammatory conditions in the Indian centre, whereas the most common in the Singaporean centre were cataract in the pre- or postoperative stage and glaucoma. For patients from the Indian centre, 61.9% felt that COVID-19 had negatively impacted their eye disease, 58.7% were more distressed by their eye disease, 70.8% could not access appropriate eye care, 66.6% were afraid of contracting COVID-19 in the clinic, and 61.9% were accepting of teleconsultations. For patients from the Singaporean centre, 13.5% felt that COVID-19 had negatively impacted their eye disease, 19.5% were more distressed by their eye disease, 21.5% could not access appropriate eye care, 35% were afraid of contracting COVID-19 in the clinic, and only 31% were accepting of teleconsultations. Conclusion Patients from India appear to have been more negatively affected by the pandemic compared to patients from Singapore. This study highlights patients’ perceptions of the impact of COVID-19 on eye care, perceived risks, ease of access to care and attitudes towards eye care during the pandemic. Patients’ perceptions are integral in developing strategies for the best care possible. There were heterogeneous responses amongst our patients; hence, there may be a role for more individualized healthcare strategies in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00444-0.

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New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic

Cited by 33 publications

References 23 publications

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

Cross-hierarchical Integrative Research Network for Heterogenetic Eye Disease Toward P4 Medicine: A Narrative Review

Eye Care During the COVID-19 Pandemic: A Report on Patients’ Perceptions and Experiences, an Asian Perspective

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