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Loewenstein A, Berger A, Daly A, Creuzot-Garcher C, Gale R, Ricci F, Zarranz-Ventura J, Guymer R. Save our Sight (SOS): a collective call-to-action for enhanced retinal care across health systems in high income countries. Eye (Lond) 2023; 37:3351-3359. [PMID: 37280350 PMCID: PMC10630379 DOI: 10.1038/s41433-023-02540-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 06/08/2023] Open
Abstract
With a growing aging population, the prevalence of age-related eye disease and associated eye care is expected to increase. The anticipated growth in demand, coupled with recent medical advances that have transformed eye care for people living with retinal diseases, particularly neovascular age-related macular degeneration (nAMD) and diabetic eye disease, has presented an opportunity for health systems to proactively manage the expected burden of these diseases. To do so, we must take collective action to address existing and anticipated capacity limitations by designing and implementing sustainable strategies that enable health systems to provide an optimal standard of care. Sufficient capacity will enable us to streamline and personalize the patient experience, reduce treatment burden, enable more equitable access to care and ensure optimal health outcomes. Through a multi-modal approach that gathered unbiased perspectives from clinical experts and patient advocates from eight high-income countries, substantiated perspectives with evidence from the published literature and validated findings with the broader eye care community, we have exposed capacity challenges that are motivating the community to take action and advocate for change. Herein, we propose a collective call-to-action for the future management of retinal diseases and potential strategies to achieve better health outcomes for individuals at-risk of, or living with, retinal disease.
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Affiliation(s)
- Anat Loewenstein
- Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Alan Berger
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Toronto Retina Institute, Toronto, ON, Canada
| | | | | | - Richard Gale
- Hull York Medical School, University of York, York, UK
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Federico Ricci
- Dept. Experimental Medicine - University Tor Vergata of Rome, Rome, Italy
| | - Javier Zarranz-Ventura
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- August Pi and Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Robyn Guymer
- Centre for Eye Research, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
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Matos DB, Barão RC, José P, Cabrita A, Barata AD, Pinto LA. Glaucoma triage system: results of implementing a virtual clinic. Graefes Arch Clin Exp Ophthalmol 2023; 261:2367-2374. [PMID: 36995440 PMCID: PMC10368548 DOI: 10.1007/s00417-023-06039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/12/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE This study describes the virtual clinic triage system implementation process at Hospital Santa Maria-Centro Hospitalar Universitário Lisboa Norte (HSM-CHULN) and analyzes its results regarding healthcare outcomes for the patients and the system. METHODS A retrospective analysis was performed, comparing two cohorts (pre-virtual cohort; virtual triage cohort). Outcomes related to waiting time, number of hospital visits, decisions at first contact, and ancillary exam-based decisions were reported. RESULTS Two hundred and ninety-two charts were reviewed (pre-virtual cohort: 132; virtual cohort: 160). Mean waiting time between referral and the first medical contact with the glaucoma department decreased on average by 71.3 days (human contact: 286.6 days; virtual triage contact: 215.3 days). Triage system significantly decreased waiting time for glaucoma patients, with an average decrease of 326.8 days between referral and treatment decision. Triage staging allowed to label 107 (66.9; 95% confidence intervals (CI): 59.6%, 74.2%) as non-urgent; 30 (18.8%; 95% CI: 12.7%, 24.9%) as urgent, and 23 (14.3%; 95% CI: 8.9%, 19.7%) as immediate contact, with the scheduling of future appointments reflecting National Institute for Health and Care Excellence (NICE) guidelines in every patient. Moreover, the number of visits to perform the same exams and obtain the same clinical decisions was reduced by 63.6%. CONCLUSION Our virtual screening strategy significantly decreased waiting time, number of hospital visits, and increased chances of data-assisted clinical decision. While results can be further improved, this system can add value in an overburdened healthcare system, where triage systems with remote decision-making may be valuable tools in optimizing glaucoma care, even without allocation of extra resources.
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Affiliation(s)
- Diogo Bernardo Matos
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal.
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
- Departamento de Oftalmologia, Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Rafael Correia Barão
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Patrícia José
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Afonso Cabrita
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - André Diogo Barata
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Luís Abegão Pinto
- Centro Hospitalar Universitário Lisboa Norte - Hospital Santa Maria, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Amigoni F, Lega F, Maggioni E. Insights into how universal, tax-funded, single payer health systems manage their waiting lists: A review of the literature. Health Serv Manage Res 2023:9514848231186773. [PMID: 37394445 DOI: 10.1177/09514848231186773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background: A conspicuous consequence of gatekeeping arrangements in universal, tax-funded, single-payer health care systems is the long waiting times. Besides limiting equal access to care, long waiting times can have a negative impact on health outcomes. Long waiting times can create obstacles in a patient's care pathway. Organization for Economic Co-operation and Development (OECD) countries have implemented various strategies to tackle this issue, but there is little evidence for which approach is the most effective. This literature review examined waiting times for ambulatory care. Objective: The aim was to identify the main policies or combinations of policies universal, tax-funded, and single-payer healthcare systems have implemented to improve the governance of outpatient waiting times. Methods: Starting from 1040 potentially eligible articles, a total of 41 studies were identified via a 2-step selection process. Findings: Despite the relevance of the issue, the literature is limited. A set of 15 policies for the governance of ambulatory waiting time was identified and categorized by the type of intervention: generation of supply capacity, control of demand, and mixed interventions. Even if a primary intervention was always identifiable, rarely a policy was implemented solo. The most frequent primary strategies were: guidelines implementation and/or clinical pathways, including triage, guidelines for referral and maxim waiting times (14 studies), task shifting (9 studies), and telemedicine (6 studies). Most studies were observational, with no data on costs of intervention and impact on clinical outcomes.
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Affiliation(s)
- Francesco Amigoni
- European Master in Health Economics and Management, MCI Management Center Innsbruck Internationale Hochschule GmbH, Innsbruck, Austria
| | - Federico Lega
- Department of Biomedical Sciences for Health and Acting Director of the Research Center in Health Administration (HEAD), University of Milan, Milano, Italy
| | - Elena Maggioni
- Research Center in Health Administration (HEAD), University of Milan, Milano, Italy
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4
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Ho S, Kalloniatis M, Ly A. Clinical decision support in primary care for better diagnosis and management of retinal disease. Clin Exp Optom 2022; 105:562-572. [PMID: 35025728 DOI: 10.1080/08164622.2021.2008791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Misdiagnosis of retinal disease is a common problem in primary care that can lead to irreversible vision loss and false-positive referrals, resulting in inappropriate use of health services. Clinical decision support systems describe tools that leverage information technology to provide timely recommendations that assist clinicians in the decisions they make about the care of a patient. They, therefore, have the potential to reduce the rate of misdiagnosis by promoting evidence-based medicine and more effective and efficient healthcare. This narrative review aims to support primary care practitioners in better understanding the current and emerging capacity of clinical decision support systems in eye care. Different types of clinical decision support systems are discussed, using current examples and evidence from the available literature to demonstrate how they may improve diagnostic effectiveness and aid the management of retinal disease. Comments are made on the future directions of clinical decision support in primary eye care and the potential applications of artificial intelligence.
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Affiliation(s)
- Sharon Ho
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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5
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Walsh L, Hong SC, Chalakkal RJ, Ogbuehi KC. A Systematic Review of Current Teleophthalmology Services in New Zealand Compared to the Four Comparable Countries of the United Kingdom, Australia, United States of America (USA) and Canada. Clin Ophthalmol 2021; 15:4015-4027. [PMID: 34675470 PMCID: PMC8500493 DOI: 10.2147/opth.s294428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
Background Over 700,000 New Zealanders (NZ), particularly elderly and Māori, live without timely access to specialist ophthalmology services. Teleophthalmology is a widely recognised tool that can assist in overcoming resource and distance barriers. Teleophthalmology gained unprecedented traction in NZ during the COVID-19 pandemic and subsequent lockdown. However, its provision is still limited and there are equity issues. The aim of this study was to conduct a systematic review identifying, describing and contrasting teleophthalmology services in NZ with the comparable countries of Australia, USA, Canada and the United Kingdom. Methods The electronic databases Embase, PubMed, Web of Science, Google Scholar and Google were systemically searched using the keywords: telemedicine, ophthalmology, tele-ophthalmology/teleophthalmology. The searches were filtered to the countries above, with no time constraints. An integrative approach was used to synthesise findings. Results One hundred and thirty-two studies were identified describing 90 discrete teleophthalmology services. Articles spanned from 1997 to 2020. Models were categorised into general eye care (n=21; 16%); emergency/trauma (n=6; 4.5%); school screening (n=25; 19%); artificial intelligence (AI) (n=23; 18%); and disease-specific models of care (MOC) (n=57; 43%). The most common diseases addressed were diabetic retinopathy (n=23; 17%); retinopathy of prematurity (n=9; 7%); and glaucoma (n=8; 6%). Programs were mainly centred in the US (n=72; 54.5%), followed by the UK (n=29; 22%), then Canada (n=16; 12%), Australia (n=13; 10%), with the fewest identified in NZ (n=3; 2%). Models generally involved an ophthalmologist consultative service, remote supervision and triaging. Most models involved local clinicians transmitting fed-forward or live images. Conclusion Teleophthalmology will likely play a crucial role in the future of eye care. COVID-19 has offered a unique opportunity to observe the use of teleophthalmology services globally. Feed-forward and, increasingly, live-based teleophthalmology services have demonstrated feasibility and cost-effectiveness in similar countries internationally. New Zealand’s teleophthalmology services, however, are currently limited. Investing in strategic partnerships and technology at a national level can advance health equities in ophthalmic care.
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Affiliation(s)
- Liam Walsh
- Department of Ophthalmology, Southern District Health Board, Dunedin, Otago, New Zealand
| | - Sheng Chiong Hong
- Department of Ophthalmology, Southern District Health Board, Dunedin, Otago, New Zealand
| | - Renoh Johnson Chalakkal
- Research and Development, oDocs Eye Care, Dunedin, Otago, New Zealand.,Electrical and Computer Engineering, University of Auckland, Auckland, New Zealand
| | - Kelechi C Ogbuehi
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
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6
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Li JPO, Liu H, Ting DSJ, Jeon S, Chan RVP, Kim JE, Sim DA, Thomas PBM, Lin H, Chen Y, Sakomoto T, Loewenstein A, Lam DSC, Pasquale LR, Wong TY, Lam LA, Ting DSW. Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective. Prog Retin Eye Res 2021; 82:100900. [PMID: 32898686 PMCID: PMC7474840 DOI: 10.1016/j.preteyeres.2020.100900] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022]
Abstract
The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.
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Affiliation(s)
- Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hanruo Liu
- Beijing Tongren Hospital; Capital Medical University; Beijing Institute of Ophthalmology; Beijing, China
| | - Darren S J Ting
- Academic Ophthalmology, University of Nottingham, United Kingdom
| | - Sohee Jeon
- Keye Eye Center, Seoul, Republic of Korea
| | | | - Judy E Kim
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Peter B M Thomas
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Haotian Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Youxin Chen
- Peking Union Medical College Hospital, Beijing, China
| | - Taiji Sakomoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | | | - Dennis S C Lam
- C-MER Dennis Lam Eye Center, C-Mer International Eye Care Group Limited, Hong Kong, Hong Kong; International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tien Y Wong
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore
| | - Linda A Lam
- USC Roski Eye Institute, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel S W Ting
- Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore.
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7
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Gale RP, Mahmood S, Devonport H, Patel PJ, Ross AH, Walters G, Downey L, El-Sherbiny S, Freeman M, Berry S, Jain N. Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service. Eye (Lond) 2020; 33:1-21. [PMID: 30926932 PMCID: PMC6474281 DOI: 10.1038/s41433-018-0300-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This publication and the expert roundtable meeting on which the article is based were sponsored by Bayer plc. Prescribing information for Eylea® (aflibercept solution for injection) can be found at the end of the article. This report by a group of UK retina specialists and health professionals considers best practice recommendations for the management of sight-threatening neovascular age-related macular degeneration (nAMD), based on collective experience and expertise in routine clinical practice. The authors provide an update for ophthalmologists, allied healthcare professionals and commissioners on practice principles for optimal patient care and service provision standards. Refinement of care pathways for nAMD has improved access to intravitreal anti-vascular endothelial growth factor therapy but there are still variations in care and reported outcomes between clinic centres. Innovative organisational models of service provision allow providers to better match capacity with increasing demand. The authors review the recent NICE guideline for diagnosis and management of AMD, considerations for switching therapies and stopping treatment and need for regular monitoring of non-affected fellow eyes in patients with unilateral nAMD. Actions for delivery of high-quality care and to improve long-term patient outcomes are discussed. Local pathways need to detail nAMD target time to treat, maintenance of review intervals to ensure proactive treatment regimens are delivered on time and appropriate discharge for patients deemed low risk or no longer benefiting from treatment. Actual visual acuity outcomes achieved and maintenance of the level of vision when disease stability is achieved are considered good measures for judging the quality of care in the treatment of patients with nAMD. Robust community referral pathways must be in place for suspected reactivation of choroidal neovascularisation and rapid referral for second eye involvement. Practical considerations for intravitreal injection therapy are outlined.
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Affiliation(s)
- Richard P Gale
- The Action on nAMD Group, Birmingham, UK. .,The York Hospital, York, UK.
| | - Sajjad Mahmood
- The Action on nAMD Group, Birmingham, UK.,Manchester Royal Eye Hospital, Manchester, UK
| | - Helen Devonport
- The Action on nAMD Group, Birmingham, UK.,Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Praveen J Patel
- The Action on nAMD Group, Birmingham, UK.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adam H Ross
- The Action on nAMD Group, Birmingham, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gavin Walters
- The Action on nAMD Group, Birmingham, UK.,Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Louise Downey
- The Action on nAMD Group, Birmingham, UK.,Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Samer El-Sherbiny
- The Action on nAMD Group, Birmingham, UK.,South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Mary Freeman
- The Action on nAMD Group, Birmingham, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Berry
- The Action on nAMD Group, Birmingham, UK.,Simon Berry Optometrist, Durham, UK
| | - Nitin Jain
- The Action on nAMD Group, Birmingham, UK.,Bayer, Reading, UK
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8
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Naiker U, FitzGerald G, Dulhunty JM, Rosemann M. Time to wait: a systematic review of strategies that affect out-patient waiting times. AUST HEALTH REV 2019; 42:286-293. [PMID: 28355525 DOI: 10.1071/ah16275] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022]
Abstract
Objective Out-patient waiting times pose a significant challenge for public patients in need of specialist evaluation and intervention. The aim of the present study was to identify and categorise effective strategies to reduce waiting times for specialist out-patient services with a focus on the Australian healthcare system. Methods A systematic review of major health databases was conducted using the key terms 'outpatient*' AND 'waiting time', 'process*' AND 'improvement in outpatient clinics'. Identified articles were assessed for their relevance by sequential review of the title, abstract and full text. References of the selected manuscripts were scanned for additional relevant articles. Selected articles were evaluated for consistent and emerging themes. Results In all, 152 articles were screened, of which 38 were included in the present review. Numerous strategies identified in the articles were consolidated into 26 consistent approaches. Three overarching themes were identified as significantly affecting waiting times: resource realignment, operational efficiency and process improvement. Conclusions Strategies to align resources, increase operational efficiency and improve processes provide a comprehensive approach that may reduce out-patient waiting times. What is known about the topic? Out-patient waiting times are a challenge in most countries that seek to provide universal access to health care for all citizens. Although there has been extensive research in this area, many patients still experience extensive delays accessing specialist care, particularly in the public health sector. The multiple factors that contribute to bottlenecks and inefficiencies in the referral process and affect patient waiting times are often poorly understood. What does this paper add? This paper reviews the published healthcare literature to identify strategies that affect specialist out-patient waiting times for patients. The findings suggest that there are numerous operational strategies that affect waiting times. These strategies may be categorised into three overarching themes (resource alignment, operational efficiencies and out-patient processes) that, when actioned in a coordinated approach, have the potential to significantly reduce out-patient waiting times. What are the implications for practitioners? This paper identifies evidence-based strategies for aligning resources, improving operational efficiency and streamlining processes, which may provide improvements to specialist out-patient waiting times for patients. Addressing the identified organisational, person-related, cultural and attitudinal factors will assist health system managers and health practitioners target the most appropriate improvement activities to reduce waiting times.
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Affiliation(s)
- Ugenthiri Naiker
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Gerry FitzGerald
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Joel M Dulhunty
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia. Email
| | - Michael Rosemann
- School of Information Systems, Science and Engineering Faculty, Queensland University of Technology, 2 George Street, Brisbane, Qld, 4000. Email
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Kern C, Fu DJ, Kortuem K, Huemer J, Barker D, Davis A, Balaskas K, Keane PA, McKinnon T, Sim DA. Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care. Br J Ophthalmol 2019; 104:312-317. [PMID: 31320383 PMCID: PMC7041498 DOI: 10.1136/bjophthalmol-2019-314161] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists. METHODS Retrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals. RESULTS After reviewing the patient's data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4-8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7-3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common. CONCLUSION After implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.
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Affiliation(s)
- Christoph Kern
- Moorfields Eye Hospital, London, United Kingdom.,Department of Ophthalmology, University Eye Hospital, LMU, Munich, Germany
| | - Dun Jack Fu
- Moorfields Eye Hospital, London, United Kingdom
| | - Karsten Kortuem
- Moorfields Eye Hospital, London, United Kingdom.,Department of Ophthalmology, University Eye Hospital, LMU, Munich, Germany
| | - Josef Huemer
- Moorfields Eye Hospital, London, United Kingdom.,Eye Departement, Tauernklinikum, Zell am See, Austria
| | | | | | | | - Pearse A Keane
- Moorfields Eye Hospital, London, United Kingdom.,NIHR Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College of London, London, United Kingdom
| | | | - Dawn A Sim
- Moorfields Eye Hospital, London, United Kingdom .,NIHR Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College of London, London, United Kingdom
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10
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Determining Optic Nerve Cupping Using Optical Coherence Tomography (OCT) Versus a New Electronic Mobile Device. J Glaucoma 2019; 28:398-403. [PMID: 31048637 DOI: 10.1097/ijg.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present a new device that may aid in glaucoma screening. The vertical cup-to-disc ratio (CDR) obtained from a new electronic mobile device (EMD) was compared with that obtained from a spectral-domain optical coherence tomography. In addition, results from examiner's evaluations were compared with the results mentioned above. METHODS A single-masked study was performed to evaluate the CDR results from 110 eyes from 110 subjects whose ages ranged between 18 and 60 years (39±13 y old), of whom 66 (60%) were female individuals. Vertical CDR was analyzed 5 times with each device in a single visit and evaluated by 3 different ophthalmologists. The Spearman correlation test and Bland-Altman analysis were used to evaluate the correlation and agreement between methods. RESULTS The CDR average using spectral-domain optical coherence tomography was 0.47±0.04, whereas the CDR average using EMD was 0.42±0.02. The clinical evaluation resulted in an average of 0.34±0.27. The Spearman test showed a strong correlation between vertical CDR obtained with both devices (r=0.8319; P<0.0001) and between EMD and the examiners (r=0.7156; P>0.001). Bland-Altman analysis showed good agreement between both devices as well as between EMD and the examiners (95% limits of agreement from -0.20 to 0.10 and from -0.15 to 0.30, respectively). CONCLUSIONS We present a low-cost, reliable EMD that may serve as an alternative to subjectively measuring vertical CDR in face-to-face consultations and hence increase the general public's access to glaucoma screening. This may be especially useful for patients who live in remote areas.
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11
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Caffery LJ, Taylor M, Gole G, Smith AC. Models of care in tele-ophthalmology: A scoping review. J Telemed Telecare 2017; 25:106-122. [DOI: 10.1177/1357633x17742182] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | - Monica Taylor
- Centre for Online Health, The University of Queensland, Australia
| | - Glen Gole
- Children’s Health Queensland, Queensland Children’s Hospital, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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Jeganathan VSE, Hall HN, Sanders R. Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective. Asia Pac J Ophthalmol (Phila) 2017; 6:3-7. [PMID: 28161930 DOI: 10.22608/apo.2016110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/05/2016] [Indexed: 11/08/2022] Open
Abstract
Ophthalmology departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from community to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non-sight-threatening disease in the community.
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Affiliation(s)
- V Swetha E Jeganathan
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Queen Margaret Hospital, NHS Fife
| | - H Nikki Hall
- Queen Margaret Hospital, NHS Fife
- University of Edinburgh, Edinburgh
- Princess Alexander Eye Pavillion, Edinburgh, Scotland, UK
| | - Roshini Sanders
- Queen Margaret Hospital, NHS Fife
- Princess Alexander Eye Pavillion, Edinburgh, Scotland, UK
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Razavi H, Copeland SP, Turner AW. Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service. Aust J Rural Health 2016; 25:45-52. [DOI: 10.1111/ajr.12277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hessom Razavi
- Lions Eye Institute; Perth Western Australia Australia
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