Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services

Blandford, Ann; Abdi, Sarah; Aristidou, Angela; Carmichael, Josie; Cappellaro, Giulia; Hussain, Rima; Balaskas, Konstantinos

doi:10.1136/bmjopen-2022-060810

Cited by 4 publications

(4 citation statements)

References 55 publications

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“… 87 Although optometrists have expressed positive attitudes towards the future use of AI in primary care as a diagnostic tool for retinal disease, 90 we found no investigations that have implemented or piloted AI specifically for the diagnosis/management of patients referred from primary care optometry to the HES. Protocols have been published which describe a pilot study 91 , 92 currently taking place in London using a cluster randomised trial to evaluate a teleophthalmology referral pathway for retinal disease. This includes assessment of the accuracy of an AI diagnostic support system for automated diagnosis and referral recommendation.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

Carmichael,

Abdi,

Balaskas

et al. 2023

Ophthalmic Physiologic Optic

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PurposeOphthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department within the National Health Service. Recognising the need for intervention, several approaches have been trialled to tackle the high numbers of false‐positive referrals initiated in primary care and seen face to face within the hospital eye service (HES). In this mixed‐methods narrative synthesis, we explored interventions based on their clinical impact, cost and acceptability to determine whether they are clinically effective, safe and sustainable. A systematic literature search of PubMed, MEDLINE and CINAHL, guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA), was used to identify appropriate studies published between December 2001 and December 2022.Recent FindingsA total of 55 studies were reviewed. Four main interventions were assessed, where two studies covered more than one type: training and guidelines (n = 8), referral filtering schemes (n = 32), asynchronous teleophthalmology (n = 13) and synchronous teleophthalmology (n = 5). All four approaches demonstrated effectiveness for reducing false‐positive referrals to the HES. There was sufficient evidence for stakeholder acceptance and cost‐effectiveness of referral filtering schemes; however, cost comparisons involved assumptions. Referral filtering and asynchronous teleophthalmology reported moderate levels of false‐negative cases (2%–20%), defined as discharged patients requiring HES monitoring.SummaryThe effectiveness of interventions varied depending on which outcome and stakeholder was considered. More studies are required to explore stakeholder opinions around all interventions. In order to maximise clinical safety, it may be appropriate to combine more than one approach, such as referral filtering schemes with virtual review of discharged patients to assess the rate of false‐negative cases. The implementation of a successful intervention is more complex than a ‘one‐size‐fits‐all’ approach and there is potential space for newer types of interventions, such as artificial intelligence clinical support systems within the referral pathway.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

Carmichael,

Abdi,

Balaskas

et al. 2023

Ophthalmic Physiologic Optic

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“…This study’s overall aims, objectives, and recruitment strategy are detailed elsewhere; 13 we summarise key points here. We undertook semistructured interviews with 41 participants from across the UK, between December 2021 and May 2022.…”

Section: Methodsmentioning

confidence: 99%

“…Eighteen patients were consulted in the planning and development of the wider HERMES study, which has been detailed in the protocol paper. 13 The insights raised about understanding the benefits of teleophthalmology contributed to the design of this qualitative study. As noted above, 17 patients participated in interviews.…”

Section: Methodsmentioning

confidence: 99%

What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians

Patel,

Abdi,

Carmichael

et al. 2024

BMJ Open

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Objective Implementing teleophthalmology into the optometric referral pathway may ease the current pressures on hospital eye services caused by over-referrals from some optometrists. This study aimed to understand the practical implications of implementing teleophthalmology by analysing lived experiences and perceptions of teleophthalmology in the optometric referral pathway for suspected retinal conditions. Design Qualitative in-depth interview study Setting Fourteen primary care optometry practices and four secondary care hospital eye services from four NHS Foundation Trusts across the UK. Participants We interviewed 41 participants: patients (17), optometrists (18), and ophthalmologists (6) who were involved in the HERMES study. Through thematic analysis, we collated and present their experiences of implementing teleophthalmology. Results All participants interviewed were positive towards teleophthalmology as it could enable efficiencies in the referral pathway and improve feedback and communication between patients and healthcare professionals. Concerns included setup costs for optometrists and anxieties from patients about not seeing an ophthalmologist face to face. However, reducing unnecessary visits and increasing the availability of resources and capacity were seen as significant benefits. Conclusions Overall, we report positive experiences of implementing teleophthalmology into the optometric referral pathway for suspected retinal conditions. Successful implementation will require appropriate investment to set up and integrate new technology and remunerate services, and continued evaluation to ensure timely feedback to patients and between healthcare professionals is received. Trial registration number nct18106677.

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“…Retinal OCT scans form the substrate for several clinical AI tools, which anatomically segment the images to support various clinical decisions including triage and diagnosis 12. The impact of these clinical AI functions on the efficacy and efficiency of primary to secondary care referrals in ophthalmology are the subject of ongoing prospective clinical studies 13 14. However, an even greater cumulative demand on ophthalmologists’ time is making decisions about the treatment of nAMD within secondary care.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of an artificial intelligence-enabled decision tool for treatment decisions in neovascular age-related macular degeneration and an exploration of clinical pathway integration and implementation: protocol for a multi-methods validation study

et al. 2023

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IntroductionNeovascular age-related macular degeneration (nAMD) management is one of the largest single-disease contributors to hospital outpatient appointments. Partial automation of nAMD treatment decisions could reduce demands on clinician time. Established artificial intelligence (AI)-enabled retinal imaging analysis tools, could be applied to this use-case, but are not yet validated for it. A primary qualitative investigation of stakeholder perceptions of such an AI-enabled decision tool is also absent. This multi-methods study aims to establish the safety and efficacy of an AI-enabled decision tool for nAMD treatment decisions and understand where on the clinical pathway it could sit and what factors are likely to influence its implementation.Methods and analysisSingle-centre retrospective imaging and clinical data will be collected from nAMD clinic visits at a National Health Service (NHS) teaching hospital ophthalmology service, including judgements of nAMD disease stability or activity made in real-world consultant-led-care. Dataset size will be set by a power calculation using the first 127 randomly sampled eligible clinic visits. An AI-enabled retinal segmentation tool and a rule-based decision tree will independently analyse imaging data to report nAMD stability or activity for each of these clinic visits. Independently, an external reading centre will receive both clinical and imaging data to generate an enhanced reference standard for each clinic visit. The non-inferiority of the relative negative predictive value of AI-enabled reports on disease activity relative to consultant-led-care judgements will then be tested. In parallel, approximately 40 semi-structured interviews will be conducted with key nAMD service stakeholders, including patients. Transcripts will be coded using a theoretical framework and thematic analysis will follow.Ethics and disseminationNHS Research Ethics Committee and UK Health Research Authority approvals are in place (21/NW/0138). Informed consent is planned for interview participants only. Written and oral dissemination is planned to public, clinical, academic and commercial stakeholders.

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Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services

Cited by 4 publications

References 55 publications

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians

Safety and efficacy of an artificial intelligence-enabled decision tool for treatment decisions in neovascular age-related macular degeneration and an exploration of clinical pathway integration and implementation: protocol for a multi-methods validation study

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