Long-term Comparative Effectiveness of Telemedicine in Providing Diabetic Retinopathy Screening Examinations: A Randomized Clinical Trial.
Long-term Comparative Effectiveness of Telemedicine in Providing Diabetic Retinopathy Screening Examinations: A Randomized Clinical Trial.
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DOI：
10.1001/jamaophthalmol.2015.1
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发表时间：
2015-05
影响因子：
8.1
通讯作者：
Becker TM
中科院分区：
文献类型：
--
作者：
Mansberger SL;Sheppler C;Barker G;Gardiner SK;Demirel S;Wooten K;Becker TM
关于远程医疗提供糖尿病视网膜病变筛查检查的长期比较有效性的信息很少。比较远程医疗与传统眼科检查提供糖尿病视网膜病变筛查检查的能力。从2006年8月1日至2009年9月31日，567名糖尿病受试者被随机分组，并随访至5年（患者随访的最后日期为2012年8月6日），作为多中心随机临床试验的一部分，进行意向治疗分析。我们将参与者分配到初级保健医疗诊所（n = 296）的非散瞳相机远程医疗或眼科护理专业人员（n = 271）的传统监视。注册两年后，我们为所有参与者提供远程医疗。1)接受年度糖尿病视网膜病变筛查检查的受试者百分比; 2）使用0期（无）至4期的有效量表，随访期间糖尿病视网膜病变恶化的患眼百分比（增殖性糖尿病视网膜病变）;以及3）需要转诊到眼科护理提供者以进行后续护理的远程医疗参与者的百分比，所述眼科护理提供者使用中度糖尿病视网膜病变或更糟的截止值，黄斑水肿的存在，或视网膜病变或黄斑水肿的“无法确定”结果。在6个月或更短的时间内，与传统监测组相比，远程医疗组更有可能接受糖尿病视网膜病变筛查检查。（94.6% [280/296] vs 43.9% [119/271]; 95% CI，46.6%-54.8%; P <0.001）和大于6个月至18个月（53.0% [157/296] vs 33.2% [90/271]; 95% CI，16.5%-23.1%; P < .001）时间仓。在我们为两组提供远程医疗后，我们无法确定两组之间糖尿病视网膜病变筛查检查的百分比存在差异。在4年的时间段内，409名参与者中有35名（8.5%）（95% CI，5.8%-11.2%）的糖尿病视网膜病变恶化了2期或2期以上，409名参与者中有5名（1.2%）（95% CI，0.1%-2.3%）的糖尿病视网膜病变改善了2期或2期以上。在研究期间，需要转诊的远程医疗参与者的百分比从19.2%（52/271）到27.9%（58/208）不等。远程医疗增加了糖尿病视网膜病变筛查检查的百分比;大多数参与者不需要转诊给眼科护理提供者;糖尿病视网膜病变水平在研究期间总体稳定。这表明，初级保健诊所可以使用远程医疗来筛查糖尿病视网膜病变，并在很长一段时间内监测疾病恶化。
Minimal information exists regarding the long-term comparative effectiveness of telemedicine to provide diabetic retinopathy screening exams. To compare telemedicine to traditional eye examinations in their ability to provide diabetic retinopathy screening examinations. From August 1, 2006, through September 31, 2009, 567 participants with diabetes were randomized and followed up to 5 years of follow-up (last date of patient follow-up occurred on August 6, 2012) as part of a multicenter randomized clinical trial with an intent to treat analysis. We assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). Two years after enrollment, we offered telemedicine to all participants. 1) percentage of participants receiving annual diabetic retinopathy screening exams; 2) percentage of eyes with worsening diabetic retinopathy during the follow-up period using a validated scale from Stage 0 (none) to Stage 4 (proliferative diabetic retinopathy); and 3) percentage of telemedicine participants who would require referral to an eye care provider for follow-up care using a cut-off of moderate diabetic retinopathy or worse, the presence of macular edema, or an ‘unable to determine’ result for either retinopathy or macular edema. The telemedicine group was more likely to receive a diabetic retinopathy screening exam when compared to the traditional surveillance group during the 6-month or less (94.6% [280/296] vs 43.9% [119/271]; 95% CI, 46.6%-54.8%; P < .001) and greater than 6-month through 18-month (53.0% [157/296] vs 33.2% [90/271]; 95% CI, 16.5%-23.1%; P < .001) time bins. After we offered telemedicine to both groups, we could not identify a difference between the groups in the percentage of diabetic retinopathy screening examinations. Diabetic retinopathy worsened by 2 stages or more in 35 (8.5%) of 409 participants (95% CI, 5.8%-11.2%) and improved by 2 stages or more in 5 (1.2%) of 409 participants (95% CI, 0.1%-2.3%) over the 4 year time period. The percentage of telemedicine participants requiring referral ranged from 19.2 (52/271) to 27.9% (58/208) during the study period. Telemedicine increased the percentage of diabetic retinopathy screening exams; most participants did not require referral to an eye care provider; and diabetic retinopathy levels were generally stable over the study period. This suggests that primary care clinics can use telemedicine to screen for diabetic retinopathy and monitor for disease worsening over a long period of time.
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影响因子：
13.7
作者：
Sheppler CR;Lambert WE;Gardiner SK;Becker TM;Mansberger SL
通讯作者：
Mansberger SL
DOI：
10.1016/s0008-4182(03)80111-4
发表时间：
2003-12-01
影响因子：
4.2
作者：
Choremis, J;Chow, DR
通讯作者：
Chow, DR
影响因子：
3
作者：
Marks, Jennifer B.
通讯作者：
Marks, Jennifer B.
影响因子：
16.2
作者：
Ahmed, Jehanara;Ward, Thomas P.;Vigersky, Robert A.
通讯作者：
Vigersky, Robert A.
影响因子：
4.7
作者：
Li, Helen K.;Horton, Mark;Winchester, Marc
通讯作者：
Winchester, Marc