RESUMEN
Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.
Asunto(s)
Retinopatía Diabética/diagnóstico , Satisfacción del Paciente , Población Rural , Telemedicina/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Población Negra , Estudios de Factibilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , North Carolina , Población BlancaRESUMEN
BACKGROUND: Real-time interactive teleconference clinical consultations are envisioned for increasing accessibility to medical care by patients whose demographics restrict care. There are no published studies, however, describing referrals and the referring practitioners, patients, and specialists participating in these consultations. OBJECTIVE: To assess characteristics of participants of interactive teleconference clinical consultations. DESIGN: Descriptive study, February 1, 1996, through April 30, 1999. SETTING: Eastern North Carolina: Brody School of Medicine at East Carolina University and 7 rural hospitals and clinics in its telemedicine network. SUBJECTS: Rural practitioners requesting consultations (n = 76), consulting physicians (n = 40), and patients completing evaluations following consultations (n = 495). MAIN OUTCOME MEASURES: Demographic and descriptive variables for referring providers, patients, and consulting physicians relative to the population in the region and to patients and physicians at the East Carolina University School of Medicine clinics. RESULTS: The largest number of referrals (65.2%) were made to obtain a second opinion or recommend a management plan in dermatology (33.5%), allergy (21.0%), or cardiology (17.8%). Significant patient characteristics were race (56.8% minorities), age (19.6% < or = 10 years old and 26.0% > or = 59.0 years old), sex (59% females), and insurance status (10.7% no insurance, 33.7% Medicaid, 15.4% Medicare). In addition, 38.0% had household incomes below the poverty level. Only 5.2% of the patients would have been treated by the referral practitioner, making travel necessary for consultation. Demographic characteristics of the practitioners were not statistically different. CONCLUSIONS: Participants of interactive teleconference clinical consultations are patients whose access to medical care might otherwise be limited. Use of telemedicine by practitioners is not related to age or sex. Arch Fam Med. 2000;9:1036-1040
Asunto(s)
Consulta Remota/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , North Carolina , Derivación y Consulta , Servicios de Salud RuralRESUMEN
Using telemedicine to care for homebound patients increases patients' access to care, reduces resource consumption, and improves use of scarce health professionals.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Personas Imposibilitadas , Supervisión de Enfermería/organización & administración , Telemedicina/organización & administración , Humanos , Técnicas de PlanificaciónRESUMEN
BACKGROUND: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation. OBJECTIVE: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system. METHODS: Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis. RESULTS: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians. CONCLUSION: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.
Asunto(s)
Dermatología , Consulta Remota , Enfermedades de la Piel/diagnóstico , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To review our experience with dermatology teleconsultations between East Carolina University School of Medicine in Greenville and Central Prison in Raleigh, NC. MATERIALS AND METHODS: Consultation forms kept on file in the Department of Internal Medicine served as the source of data. One physician reviewed the forms from the initial 22 months of our dermatology teleconsultation service to Central Prison. Patient demographics and the diagnoses made by the consulting physician were recorded. Recommendations were tabulated as either diagnostic or therapeutic. Diagnoses and recommendations for known HIV-positive individuals were separately recorded. RESULTS: One hundred thirty-eight dermatology teleconsultations were performed over the 22-month period. Seventy two per cent of the patients seen were African-American. The average age was 32 years. One hundred fifty-nine diagnoses were made. The most common problems were eczema and acneiform eruptions. Fifty-nine diagnostic and 252 therapeutic recommendations were made. CONCLUSION: Consultants generally were confident of their diagnoses and management decisions. Dermatologists can assist primary care physicians through telemedicine consultation.