Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Liu, Yao; Diaz, Alejandra Torres; Benkert, Ramsey

doi:10.1007/s11892-019-1187-5

Cited by 32 publications

(40 citation statements)

References 69 publications

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“…While the nature of TDRS alleviates patient-level barriers to screening, its integration into primary care clinical workflows is inconsistent, often suboptimal [ 26 ], with undefined best practices for implementation. Indeed, a significant proportion of people with diabetes treated in clinics equipped with TDRS technology remain unscreened [ 27 , 28 ], suggesting that undocumented barriers may exist at a different level, for example, that of professionals involved.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

Carvalho

Ware

Belcher

et al. 2021

Implement Sci Commun

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Background Recommended annual diabetic retinopathy (DR) screening for people with diabetes has low rates in the USA, especially in underserved populations. Telemedicine DR screening (TDRS) in primary care clinics could expand access and increase adherence. Despite this potential, studies have observed high variability in TDRS rates among clinics and over time, highlighting the need for implementation supports. Previous studies of determinants of TDRS focus on patients’ perspectives, with few studies targeting upstream multi-level barriers and facilitators. Addressing this gap, this qualitative study aimed to identify and evaluate multi-level perceived determinants of TDRS in Federally Qualified Health Centers (FQHCs), to inform the development of targeted implementation strategies. Methods We developed a theory-based semi-structured interview tool based on the Consolidated Framework for Implementation Research (CFIR). We conducted 22 key informant interviews with professionals involved in TDRS (administrators, clinicians, staff). The interviews were audio-recorded and transcribed verbatim. Reported barriers and facilitators were organized into emergent themes and classified according to CFIR constructs. Constructs influencing TDRS implementation were rated for each study site and compared across sites by the investigators. Results Professionals identified 21 main barriers and facilitators under twelve constructs of the five CFIR domains. Several identified themes were novel, whereas others corroborated previous findings in the literature (e.g., lack of time and human resources, presence of a champion). Of the 21 identified themes, 13 were classified under the CFIR’s Inner Setting domain, specifically under the constructs Compatibility and Available Resources. Themes under the Outer Setting domain (constructs External Incentives and Cost) were primarily perceived by administrators, whereas themes in other domains were perceived across all professional categories. Two Inner Setting (Leadership Engagement, Goals and Feedback) and two Process (Champion, Engaging) constructs were found to strongly distinguish sites with high versus low TDRS performance. Conclusions This study classified barriers and facilitators to TDRS as perceived by administrators, clinicians, and staff in FQHCs, then identified CFIR constructs that distinguished high- and low-performance clinics. Implementation strategies such as academic detailing and collection and communication of program data and successes to leadership; engaging of stakeholders through involvement in implementation planning; and appointment of intervention champions may therefore improve TDRS implementation and sustainment in resource-constrained settings.

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Section: Introductionmentioning

confidence: 99%

Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

Carvalho

Ware

Belcher

et al. 2021

Implement Sci Commun

View full text Add to dashboard Cite

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“…Although teleophthalmology was universally seen as valuable by our participants, cost remains a formidable barrier to obtaining such care and to widespread implementation as recently reviewed by Liu at al. [44]. The issue of cost as a barrier to using teleophthalmology for patients and clinics appear to be unique to the US due to its diverse fee for service insurance system, with the exception of the Veterans Affairs Health System.…”

Section: Discussionmentioning

confidence: 99%

Patient perceived value of teleophthalmology in an urban, low income US population with diabetes

et al. 2020

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Dilated eye exams are the standard of care to detect advancing, vision threatening, but often asymptomatic retinopathy in a timely fashion, allowing for vision preserving treatments. Annual exam rates are suboptimal, especially in underserved populations. Although teleophthalmology programs tremendously improve annual exam rates in low income/under resourced settings, widespread adoption is limited. Using a mixed methods approach, three focus groups and individual interviews were conducted for patients with type 2 diabetes (N = 23) who had a teleophthalmology exam or a dilated eye exam. A survey and discussion assessed patients' perspectives and value of teleophthalmology, including willingness to pay (WTP). Financial, transportation, and motivational barriers to obtaining an annual dilated eye exam were identified. Patients greatly valued having primary care (PC) based teleophthalmology for its convenience and ability to detect disease to allow for timely treatment and would recommend such a service. Although their WTP was at least the amount of their usual copay, cost was universally cited as a concern. Having a conveniently offered PC based teleophthalmology exam was valued. Educating patients on the value and costs of having such exams may be helpful to encourage informed discussions on eye care, especially in low income, underserved populations. Our study is among the few to provide insight on the value and perceptions of teleophthalmology in US low income, urban minority populations needed to help increase uptake of this innovation. Using surveys followed by facilitated discussion allowed for richer and more varied responses.

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“…Obtaining accurate visual acuity and clinical examination for future comparison may be difficult and is no substitute for face-to-face clinical examination. Nonetheless, with the advancement of technology, teleophthalmology offers an opportunity to deliver some suitable services remotely and provides a way to reduce the carbon footprint of services whilst allowing access to care in geographically isolated areas [ 57 , 58 ].…”

Section: Restructuring Ophthalmic Delivery Of Carementioning

confidence: 99%

Ophthalmology Going Greener: A Narrative Review

et al. 2021

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The combined effects of fossil fuel combustion, mass agricultural production and deforestation, industrialisation and the evolution of modern transport systems have resulted in high levels of carbon emissions and accumulation of greenhouse gases, causing profound climate change and ozone layer depletion. The consequential depletion of Earth’s natural ecosystems and biodiversity is not only a devastating loss but a threat to human health. Sustainability—the ability to continue activities indefinitely—underpins the principal solutions to these problems. Globally, the healthcare sector is a major contributor to carbon emissions, with waste production and transport systems being amongst the highest contributing factors. The aim of this review is to explore modalities by which the healthcare sector, particularly ophthalmology, can reduce carbon emissions, related costs and overall environmental impact, whilst maintaining a high standard of patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00404-8.

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Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Cited by 32 publications

References 69 publications

Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

Evaluation of multi-level barriers and facilitators in a large diabetic retinopathy screening program in federally qualified health centers: a qualitative study

Patient perceived value of teleophthalmology in an urban, low income US population with diabetes

Ophthalmology Going Greener: A Narrative Review

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