Mailed letter versus phone call to increase diabetic retinopathy screening engagement by patients in a team-based primary care practice: a prospective, single-masked, randomized trial.

2021 ◽  
Author(s):  
Vess Stamenova ◽  
Megan Nguyen ◽  
Nike Onabajo ◽  
Rebecca Merritt ◽  
Olivera Sutakovic ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Usual Care ◽  
Patient Engagement ◽  
Primary Care Practice ◽  
Phone Call ◽  
Care Practice ◽  
Diabetic Retinopathy Screening ◽  
Engagement Strategies ◽  
Retinopathy Screening

Abstract Background: Diabetic retinopathy is the leading cause of blindness among adults, but vision loss is preventable through regular screening. Urban areas in Canada have large numbers of unscreened individuals and teleophthalmology programs have been used to improve access and uptake of screening. The purpose of this study was to test different patient engagement approaches to expand teleophthalmology program to team-based primary care clinic in the city of Toronto, Canada.Methods: A teleophthalmology program was set up in a large urban academic team-based primary care practice. Patients over 18 years of age, with type 1 or type 2 diabetes were randomized to one of four engagement strategies: a phone call, a letter, a letter plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for diabetic retinopathy screening through a teleophthalmology program at the time of the call or within one week for the mail intervention. Results: A total of 23 patients in the phone, 28 in the mail, 32 in the mail and phone, and 27 in the control (usual care) were included in the analysis. After the intervention, 88% of patients in the phone intervention, 11% of patients in the mail group, and 100% in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (p< .0001), while sending a letter had no effect. Conclusions: Patient engagement to book diabetic retinopathy screening via teleophthalmology in an urban academic team-based primary care practice using telephone calls was much more effective than letters or usual care. Practices that have access to a local DR screening programs and have the required resources to undertake such engagement strategies should consider using them as a means in improving their DR screening rates.

scholarly journals Improving Patient Access to Diabetic Retinopathy Screening Through Telemedicine

Iproceedings ◽  
10.2196/15193 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15193
Author(s):  
Tiffany Wandy ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Practice ◽  
Primary Care Providers ◽  
Care Practice ◽  
Type I ◽  
Screening Measure ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Background The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 20,000 Medicare beneficiaries, many of whom have type I or type II diabetes. Diabetic retinopathy (DR) screening is extremely important in helping to preserve patient’s eyesight and overall functional status. However, like many other organizations, LBH has struggled with low compliance rates for DR screening. As result, LBH searched for a solution to improve DR screening care and improve ACO quality and financial performance. Objective LifeBridge sought a telemedicine diagnostic solution that was easy for our physicians and clinic teams to use that would enable improved management of patients with diabetes. A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices. Methods We used a pre-post test design to measure whether implementation of this tool enabled providers to better meet the diabetic retinopathy screening measure. We included the final months of 2017 in the preperiod to account for any operational changes required to implement the new workflow. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible to determine the proportion of patients who met the measure. This was done quarterly in every primary care practice throughout the organization. One of the three practice sites was changed halfway through 2018 and switched to another; however, both practices were included in the analysis. We also compared the number of diabetes patients in the populations of each of the four practices. A two sample z test with a P value of .05 was used to test for statistical significance. Results As of April 2019, 810 patients were screened for diabetic retinopathy. Of these, 33.1% (282 patients) were diagnosed with pathology. Approximately 15.6% (n=133) were diagnosed with DR. We also identified 87 patients who are considered “IRIS saves” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Statistical comparison of DR screening performance of practices pre and post implementation showed mean screening rates of 38.5% and 47.2%, respectively, with P=.01. Conclusions IRIS screenings allowed our primary care providers to provide more comprehensive care to patients with diabetes, eliminating the need for additional office visits. Having IRIS available in the practice was able to demonstrably improve performance in the diabetic retinopathy screening measure. As a result, primary care providerss with IRIS helped facilitate access to care, thus making it easier for patients make better choices related to their health outcomes. We hope to further use the data to study HbA1c control, medication adherence, and cost/utilization in those diagnosed with retinopathy compared to those with a negative screening.

scholarly journals Correction to: Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

2020 ◽  
Author(s):  
Márcia Silva Queiroz ◽  
Jacira Xavier de Carvalho ◽  
Silvia Ferreira Bortoto ◽  
Mozania Reis de Matos ◽  
Cristiane das Graças Dias Cavalcante ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

scholarly journals Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e051951
Author(s):  
Fiona Riordan ◽  
Aileen Murphy ◽  
Christina Dillon ◽  
John Browne ◽  
Patricia M Kearney ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Diabetic Retinopathy ◽  
Process Evaluation ◽  
Pilot Trial ◽  
Delivery Cost ◽  
Definitive Trial ◽  
Diabetic Retinopathy Screening ◽  
Cluster Randomised ◽  
Retinopathy Screening

ObjectivesDiabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects of an intervention to improve uptake of Ireland’s national DRS programme, Diabetic RetinaScreen, among patients with type 1 or type 2 diabetes.Design/settingWe conducted a cluster randomised pilot trial, embedded process evaluation and cost analysis in general practice, July 2019 to January 2020.ParticipantsEight practices participated in the trial. For the process evaluation, surveys were conducted with 25 staff at intervention practices. Interviews were conducted with nine staff at intervention practices, and 10 patients who received the intervention.InterventionsThe intervention comprised practice reimbursement, an audit of attendance, electronic prompts targeting professionals, General Practice-endorsed patient reminders and a patient information leaflet. Practices were randomly allocated to intervention (n=4) or wait-list control (n=4) (usual care).OutcomesStaff and patient interviews explored their perspectives on the intervention. Patient registration and attendance, including intention to attend, were measured at baseline and 6 months. Microcosting was used to estimate intervention delivery cost.ResultsThe process evaluation identified that enablers of feasibility included practice culture and capacity to protect time, systems to organise care, and staff skills, and workarounds to improve intervention ‘fit’. At 6 months, 22/71 (31%) of baseline non-attenders in intervention practices subsequently attended screening compared with 15/87 (17%) in control practices. The total delivery cost across intervention practices (patients=363) was €2509, averaging €627 per practice and €6.91 per audited patient. Continuation criteria supported proceeding to a definitive trial.ConclusionsThe Improving Diabetes Eye screening Attendance intervention is feasible in primary care; however, consideration should be given to how best to facilitate local tailoring. A definitive trial of clinical and cost-effectiveness is required with preliminary results suggesting a positive effect on uptake.Trial registration numberNCT03901898.

scholarly journals Call your doctor: prospective description study of telemedicine during the first COVID-19 outbreak in a Swiss primary care practice

2020 ◽  
Author(s):  
Joëlle Suillot ◽  
Sophie Zuercher ◽  
Lydie Zufferey ◽  
Julien Sagez
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Practice ◽  
Emergency Services ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Practice ◽  
Or Groups ◽  
Swiss Primary Care

Abstract Background: Telemedicine is a healthcare assistance method which has been promoted during the COVID-19 pandemic for the management of patients. The aim of this study is to quantify the type of request that primary care physicians are experiencing, as well as the healthcare assistance modalities and ultimately, how many physical consultations are necessary.Methods: We conducted a prospective, descriptive study in a primary care practice in Switzerland on telephone consultations related to COVID-19. The data collected included the reasons for the call, symptoms, healthcare assistance modalities and follow-up. The categorical variables are expressed as percentages of the total cases or groups.Results: We included 200 calls corresponding to 113 patients. The majority of patients (76.1%) were taken care of solely through telemedicine. The physical consultations were due to the need: for a swab test (12.4%), for a somatic assessment at the practice (9.7%) and for an emergency services consultation (1.8%). In 64.6% of cases, patient assistance required only one phone call. Calls lasted 7.85 minutes on average and were more frequent on Mondays (24%) and Fridays (18.5%). Calls led to the prescription of medication in 12.5% of cases, of a bronchodilator in 3% of cases and of an antibiotic in 0.5% of cases.Conclusion: A rigorous telephone follow-up strategy carried out by primary care physicians requires few physical consultations in patients showing symptoms of COVID-19.

scholarly journals Understanding the uptake of a national retinopathy screening programme: An audit of patients with diabetes in two large primary care centres

2019 ◽  
Vol 2 ◽  
pp. 17 ◽  
Author(s):  
Marsha Tracey ◽  
Emmy Racine ◽  
Fiona Riordan ◽  
Sheena M. McHugh ◽  
Patricia M. Kearney
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Primary Care Population ◽  
Diabetic Retinopathy Screening ◽  
A Priority ◽  
Rate Ratios ◽  
Measure Of Association ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) affects 8.2% of the Irish population with type 2 diabetes over 50 years and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods:  In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of people eligible to participate in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake (consent and attendance) should be a priority.

scholarly journals Understanding the uptake of a national retinopathy screening programme: An audit of people with diabetes in two large primary care centres

2019 ◽  
Vol 2 ◽  
pp. 17 ◽  
Author(s):  
Marsha Tracey ◽  
Emmy Racine ◽  
Fiona Riordan ◽  
Sheena M. McHugh ◽  
Patricia M. Kearney
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Programme ◽  
Primary Care Population ◽  
Diabetic Retinopathy Screening ◽  
A Priority ◽  
Rate Ratios ◽  
Measure Of Association ◽  
Primary Care Practices ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) is estimated to affect 25–26% of the Irish population with diabetes and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of eligible participants in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake, barriers to consent in particular, should be a priority.

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