Incorporation of a <i>virtual</i> assessment into a care pathway for initial glaucoma management: feasibility study

Rathod, Dinesh; Thein, Win; Pickering, Susan J.; Austin, Michael W.

doi:10.1111/j.1442-9071.2008.01831.x

Cited by 24 publications

(33 citation statements)

References 19 publications

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“…Rathod et al. (2008) reported a 94.4% diagnostic accuracy in a virtual glaucoma clinic and highlighted a potential for earlier patient diagnosis combined with advantageous cost savings (6).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model

Mark

Fitzmaurice

Haughey

et al. 2011

International Journal of Clinical Practice

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Section: Introductionmentioning

confidence: 99%

Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model

Mark

Fitzmaurice

Haughey

et al. 2011

International Journal of Clinical Practice

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“…11 Alternatively, clinical data collected from a technology-based assessment could be transferred digitally and evaluated in a virtual clinic by a glaucoma specialist to improve the positive predictive value of referrals for further ophthalmic investigation. 31,32 Cost-effectiveness may be improved by implementing a screening program that targets a number of sight-threatening eye diseases.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Technologies for Glaucoma Case-Finding in a Community Setting

et al. 2015

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“…To date, various studies have examined the agreement amongst consultant led, optometry led and teleglaucoma clinics on the diagnosis and management of glaucoma patients [15,16]. No studies have formally investigated inter-consultant agreement on individual aspects of management outcomes in a virtual clinic environment.…”

Section: Introductionmentioning

confidence: 99%

Virtual Glaucoma Clinic: Do Consultants Agree on Management Outcomes?

Kwun¹,

Nikita²

2016

J Clin Exp Ophthalmol

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Objective: To evaluate inter-examiner variations in glaucoma management amongst consultants with different levels of experience in Virtual Glaucoma Clinic. Methods:Three glaucoma specialist consultants with varying years of experience (1, 5 and 15 years) independently reviewed 112 consecutive cases. The management outcomes of the three consultants were recorded for each case on a specially designed proforma. Inter-consultant agreement on recall time, review place and treatment plan was analysed using kappa coefficient. The cohort was classified into two groups for further analysis. The first group consisted of patients in whom all three consultants agreed on management outcomes. The second group consisted of patients in whom at least one consultant disagreed on management outcomes. Unpaired student-t-test was used to calculate the difference in mean values of age, visual acuity, intraocular pressure, cup-todisc ratio and visual field mean deviation between both groups for each management outcome. Results:The percentage of overall agreement on recall time (25%) and review place (45%) was fair and moderate respectively. The overall agreement on treatment plan was superior (86%). We found significant disagreement between the senior consultant and the newly appointed consultant with lowest Kappa agreement on recall time and on review place (κ 0.14 and κ 0.22 respectively). On overall, the level of complete agreement amongst ocular hypertension was best when compared to glaucoma suspect and glaucoma. Statistical analysis revealed a tendency for disagreement amongst consultants' management outcomes on patients having more abnormal visual field and raised intraocular pressure. Conclusions:Our study demonstrates that greater difference in years of experience between consultants is associated with more disagreement in management outcomes. Discrepancies on management outcomes impact on uniformity of care and service delivery in a virtual clinic setting. We suggest the need for implementing structured management guidance in virtual glaucoma clinic to reduce discrepancies amongst consultants.Keywords: Glaucoma; Telemedicine; Virtual clinic; Inter-examiner variation; Agreement SynopsisWe found considerable disagreements amongst consultants in virtual clinic. These discrepancies were more likely the greater the difference in levels of experience separating consultants and when mean visual field was abnormal and intraocular pressure was raised.

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Incorporation of a virtual assessment into a care pathway for initial glaucoma management: feasibility study

Abstract: Clinical findings and data relating to glaucoma may be evaluated in a virtual clinic with satisfactory diagnostic accuracy.

Cited by 24 publications

References 19 publications

Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model

Assessment of the quality of care and financial impact of a virtual renal clinic compared with the traditional outpatient service model

Diagnostic Accuracy of Technologies for Glaucoma Case-Finding in a Community Setting

Virtual Glaucoma Clinic: Do Consultants Agree on Management Outcomes?

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