远程眼科避免了 COVID-19 封锁期间向二级保健机构转诊的增加。
Live teleophthalmology avoids escalation of referrals to secondary care during COVID-19 lockdown.
机构信息
Tennent Institute of Ophthalmology, NHS Greater Glasgow & Clyde, Glasgow, UK.
Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK.
出版信息
Clin Exp Optom. 2021 Aug;104(6):711-716. doi: 10.1080/08164622.2021.1916383. Epub 2021 May 20.
CLINICAL RELEVANCE
Following the COVID-19 lockdown, uptake of slitlamp-enabled live teleophthalmology increased. Its use contributed to a reduction of referrals escalated to secondary care during-lockdown (avoided: 64% pre-lockdown vs 86% during-lockdown).
BACKGROUND
Live teleophthalmology using video conferencing allows real-time, three-way consultation between secondary care, community providers and patients, improving interpretation of slit lamp findings and potentially reducing referrals to secondary care. NHS Forth Valley implemented live teleophthalmology in March 2019. In March 2020, the COVID-19 pandemic created urgency to deliver ophthalmic care while minimising the risk of contracting or spreading the disease. We aim to compare the uptake and two outcomes (number of avoided secondary care referrals; pattern of presenting conditions) of live teleophthalmology consultations in NHS Forth Valley before and during the COVID-19 national lockdown.
METHODS
An NHS secure video conferencing platform connected the video slit lamps of optometrists, or an iPad mounted on a slit lamp and viewing through the eyepieces, to a secondary care ophthalmologist via a virtual live clinic/waiting area. Data about avoiding a secondary care referral were extracted from a post-consultation ophthalmologist survey for 14 months of data. Pre- and during-lockdown intervals were before/after 23 March 2020, when routine eyecare appointments were suspended. Numbers of avoided referrals to secondary care and patterns of presenting conditions were compared for pre- and during-lockdown periods.
RESULTS
The COVID-19 pandemic markedly increased use of live teleophthalmology in NHS Forth Valley. Surveys were completed for 164 of 250 (66%) teleophthalmology consultations over the study period. Data from 154 surveys were analysed, 78 and 76 for the pre- and during-lockdown periods, respectively. Significantly more during-lockdown (86%) than pre-lockdown (64%; difference 21%, 95% CI 8-34%, p = 0.001) surveys indicated that referrals to secondary care were avoided.
CONCLUSION
Survey data from ophthalmologists suggest significantly fewer escalations to secondary care due to teleophthalmology use.
临床相关性
在 COVID-19 封锁之后，使用配备裂隙灯的远程眼科实时服务的比例有所增加。该服务的使用有助于减少封锁期间转诊至二级保健的数量（避免转诊：封锁前 64%，封锁期间 86%）。
背景
使用视频会议进行实时远程眼科服务，可实现二级保健、社区服务提供者和患者之间的实时三方咨询，有助于更好地解读裂隙灯检查结果，并可能减少转诊至二级保健的数量。NHS Forth Valley 于 2019 年 3 月开始实施远程眼科服务。2020 年 3 月，COVID-19 大流行促使我们在尽量减少感染或传播疾病风险的同时提供眼科护理。我们旨在比较 NHS Forth Valley 在 COVID-19 全国封锁前后远程眼科实时服务的使用情况和两个结果（避免转诊至二级保健的数量；就诊情况的模式）。
方法
NHS 安全视频会议平台将验光师的视频裂隙灯或通过目镜观察的安装在裂隙灯上的 iPad 与二级保健眼科医生连接起来，通过虚拟实时诊室/等候区进行连接。在为期 14 个月的数据中，从咨询后的眼科医生调查中提取了关于避免转诊至二级保健的数据。在 2020 年 3 月 23 日前后（常规眼科预约暂停），将之前和封锁期间的数据进行了比较。比较了封锁前和封锁期间避免转诊至二级保健的数量和就诊情况的模式。
结果
COVID-19 大流行使 NHS Forth Valley 对远程眼科实时服务的使用明显增加。在研究期间，共完成了 250 次远程眼科实时服务中的 164 次（66%）咨询调查。对 154 次调查进行了数据分析，分别有 78 次和 76 次来自封锁前和封锁期间。封锁期间（86%）的调查明显比封锁前（64%）的调查表示避免了转诊至二级保健（差异 21%，95%CI 8-34%，p = 0.001）。
结论
来自眼科医生的调查数据表明，由于使用了远程眼科实时服务，转诊至二级保健的数量明显减少。
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