Effectiveness and Financial Viability of Telehealth Physician Extenders for Re-Engagement of Patients with Diabetic Retinopathy

Munzar, Rachel; Anaya, Joseph A.; Lasalle, Claudia C.; Roh, Shiyoung; Ramsey, David J.

doi:10.1089/tmj.2022.0334

Cited by 3 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the effects of the coronavirus disease 2019 (COVID-19) pandemic may have caused some patients to defer eye care [ 42 ], one-third of patients who underwent TRI completed a subsequent in-person eye examination (92 patients). Three of these follow-up examinations were positive for DR (3.3%), including one patient referred because DR had been detected on TRI; the other two cases had no positive findings on TRI but were diagnosed with mild DR without macular edema by an ophthalmologist.…”

Section: Resultsmentioning

confidence: 99%

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting

Szulborski

Gumustop

Lasalle

et al. 2023

Vision

Self Cite

View full text Add to dashboard Cite

Regular eye examinations to screen for the initial signs of diabetic retinopathy (DR) are crucial for preventing vision loss. Teleretinal imaging (TRI) offered in a primary care setting provides a means to improve adherence to DR screening, particularly for patients who face challenges in visiting eye care providers regularly. The present study evaluates the utilization of TRI to screen for DR in an outpatient, hospital-based primary care clinic. Patients with diabetes mellitus (DM) but without DR were eligible for point-of-care screening facilitated by their primary care provider, utilizing a non-mydriatic, handheld fundus camera. Patient demographics and clinical characteristics were extracted from the electronic medical record. Patients who underwent TRI were more likely to be male, non-White, and have up-to-date monitoring and treatment measures, including hemoglobin A1c (HbA1c), microalbumin, and low-density lipoprotein (LDL) levels, in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. Our findings demonstrate that TRI can reduce screening costs compared to a strategy where all patients are referred for in-person eye examinations. A net present value (NPV) analysis indicates that a screening site reaches the break-even point of operation within one year if an average of two patients are screened per workday.

show abstract

Section: Resultsmentioning

confidence: 99%

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting

Szulborski

Gumustop

Lasalle

et al. 2023

Vision

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our outreach programme successfully reduced the LTFU rate by considering patient outcomes. Previous telehealth studies targeting patients with open‐angle glaucoma or diabetic retinopathy achieved higher success rates in returning patients to eye care 22–25 . This may be attributed, in part, to the younger age of patients with those conditions compared to advanced AMD.…”

Section: Discussionmentioning

confidence: 99%

“…Previous telehealth studies targeting patients with open-angle glaucoma or diabetic retinopathy achieved higher success rates in returning patients to eye care. [22][23][24][25] This may be attributed, in part, to the younger age of patients with those conditions compared to advanced AMD. While the goal was to achieve a higher return rate for in-person eye care, contacting patients, including through a family member or healthcare proxy, fulfils the obligation to provide continued care.…”

Section: Characteristicsmentioning

confidence: 99%

“…1 This study sought to identify factors associated with becoming lost to follow-up (LTFU) among patients with advanced AMD, encompassing both wet and dry forms of the disease, and evaluated the effectiveness of reintroducing patients to care through outreach conducted by a telehealth extender. While prior studies have demonstrated that telephone-based outreach reduced the LTFU rate for patients with diabetic retinopathy or open-angle glaucoma, [22][23][24][25] reengaging patients overdue for follow-up care with AMD has not been previously investigated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with loss to follow‐up in patients with advanced age‐related macular degeneration: A telehealth recall initiative

Munzar,

Roh,

Ramsey

2024

Ophthalmic Physiologic Optic

Self Cite

View full text Add to dashboard Cite

IntroductionPatients with advanced age‐related macular degeneration (AMD) frequently experience loss to follow‐up (LTFU), heightening the risk of vision loss from treatment delays. This study aimed to identify factors contributing to LTFU in patients with advanced AMD and assess the effectiveness of telephone‐based outreach in reconnecting them with eye care.MethodsA custom reporting tool identified patients with advanced AMD who had not returned for eye care between 31 October 2021 and 1 November 2022. Potentially LTFU patients were enrolled in a telephone outreach programme conducted by a telehealth extender to encourage their return for care. Linear regression analysis identified factors associated with being LTFU and likelihood of accepting care post‐outreach.ResultsOut of 1269 patients with advanced AMD, 105 (8.3%) did not return for recommended eye care. Patients LTFU were generally older (89.2 ± 8.9 years vs. 87.2 ± 8.5 years, p = 0.02) and lived farther from the clinic (25 ± 43 miles vs. 17 ± 30 miles, p = 0.009). They also had a higher rate of advanced dry AMD (26.7% vs. 18.5%, p = 0.04) and experienced worse vision in both their better‐seeing (0.683 logMAR vs. 0.566 logMAR, p = 0.03) and worse‐seeing (1.388 logMAR vs. 1.235 logMAR, p = 0.04) eyes. Outreach by a telehealth extender reached 62 patients (59%), 43 through family members or healthcare proxies. Half of the cases where a proxy was contacted revealed that the patient in question had died. Among those contacted directly, one third expressed willingness to resume eye care (20 patients), with 11 scheduling appointments (55%). Despite only two patients returning for in‐person eye care through the intervention, the LTFU rate halved to 4.4% by accounting for those patients who no longer needed eye care at the practice.ConclusionsThere is a substantial risk that older patients with advanced AMD will become LTFU. Targeted telephone outreach can provide a pathway for vulnerable patients to return to care.

show abstract

“…91 Even before 2020, telemedicine has been under evaluation as a useful tool to provide health care for rural and underserved areas. [92][93][94] While several studies focused on the quality of remote visits and their economic benefits, 92,[95][96][97] new opportunities arose in the light of the climate crisis. In a recent report on carbon emissions of the National Health Service (NHS, United Kingdom), patient and visitor travels accounted for approximately 6% of the system's CO 2 emissions (Figure 5).…”

Section: Sus Tainab Ilit Y Via Telemedicinementioning

confidence: 99%

AnEAACIreview: Go green in health care and research. Practical suggestions for sustainability in clinical practice, laboratories, and scientific meetings

Pali‐Schöll

Hermuth-Kleinschmidt²,

Dramburg

et al. 2023

Allergy

View full text Add to dashboard Cite

Health care professionals (HCPs) and researchers in the health care sector dedicate their professional life to maintaining and optimizing the health of their patients. To achieve this, significant amounts of resources are used and currently it is estimated that the health care sector contributes to more than 4% of net greenhouse gas (GHG) emissions. GHG emissions adversely impact planetary health and consequently human health, as the two are intricately linked. There are many factors of health care that contribute to these emissions. Hospitals and research labs also use high amounts of consumables which require large amounts of raw materials and energy to produce. They are further responsible for polluting the environment via disposal of plastics, drug products, and other chemicals. To maintain and develop state‐of‐the‐art best practices and treatments, medical experts exchange and update their knowledge on methods and technologies in the respective fields at highly specialized scientific meetings. These meetings necessitate thousands of attendants traveling around the globe. Therefore, while the goal of HCPs is to care for the individual, current practices have an enormous (indirect) impact on the health of the patients by their negative environmental impacts. There is an urgent need for HCPs and researchers to mitigate these detrimental effects. The installation of a sustainability‐manager at health care facilities and research organizations to implement sustainable practices while still providing quality health care is desirable. Increased use of telemedicine, virtual/hybrid conferences and green chemistry have recently been observed. The benefits of these practices need to be evaluated and implemented as appropriate. With this manuscript, we aim to increase the awareness about the negative impacts of the health care system (including health care research) on planetary and human health. We suggest some easy and highly impactful steps and encourage health care professionals and research scientists of all hierarchical levels to immediately implement them in their professional as well as private life to counteract the health care sector's detrimental effects on the environment.

show abstract

Effectiveness and Financial Viability of Telehealth Physician Extenders for Re-Engagement of Patients with Diabetic Retinopathy

Cited by 3 publications

References 17 publications

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting

Factors associated with loss to follow‐up in patients with advanced age‐related macular degeneration: A telehealth recall initiative

AnEAACIreview: Go green in health care and research. Practical suggestions for sustainability in clinical practice, laboratories, and scientific meetings

Contact Info

Product

Resources

About