Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks.
Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks.
复制标题
实施远程眼科学以改善糖尿病视网膜病变监测：实施科学框架告知的临床工作人员的定性访谈研究。
作者：
基于存储和转发相机的眼睛评估或远程眼科学是识别糖尿病视网膜病变的有效方法，糖尿病视网膜病变是美国失明的主要原因，但采用速度缓慢。了解障碍和促进者实施远程眼科计划，从那些积极采用，运行和维持这些计划是重要的广泛采用。本研究的目的是了解在引入远程眼科学，以改善获得诊断性眼科护理的糖尿病患者在初级保健诊所使用实施科学的重要因素。这项定性研究在3个城市，低收入，主要是种族和少数民族服务的安全网初级保健诊所在罗切斯特，纽约，采访了护士和医生实施远程眼科计划，通过使用的问题，告知实用，稳健的实施和可持续性模型和实施研究的综合框架。初级保健护士在他们的诊所实施该计划，增加了工作负担和缺乏自我效能的障碍。被采访者认为需要通过冠军和超级用户的在职和同行培训，对护士，医生和行政人员进行远程眼科过程的持续培训。促进者包括患者的感知便利和感知的教育优势的程序，因为它给了一个机会，为供应商与患者讨论眼睛护理的重要性。由于与护理协调有关的挑战，人们强调了对眼科转诊和跟踪的关切。该计划的财务方面（例如，患者保险和护理提供者报销）对许多工作人员来说并不清楚，影响了采用和可持续性。简化流程和工作流程，培训和分配足够的工作人员，有效协调初级保健和眼科保健之间的护理以改善随访，以及确保财务可行性，都有助于简化远程眼科的采用。
The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science. This qualitative study in 3 urban, low-income, largely racial and ethnic minority–serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research. Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability. Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.