While diabetic retinopathy is the leading cause of blindness among working age adults in the United States – and one of the most common complications from all types of diabetes – early detection and treatment can reduce that risk by up to 95 percent. However, the prevalence of diabetic retinopathy among uninsured safety net patients at the Los Angeles Department of Health Services– which has the country’s largest publicly-operated safety net population – still soars at 50 percent because of limited specialty care resources and long wait times for screenings.
But telemedicine can be a suitable, fast and efficient way to fill those screening gaps, according to a recent study conducted by the behemoth LADHS and healthcare technology company Safety Net Connect. In an article published in the journal JAMA Internal Medicine, researchers describe how the two-year collaboration using Safety Net Connect’s eConsult platform resulted in more screenings, shorter wait times and fewer in-person specialty care visits.
By deploying Safety Net Connect’s eConsult system to a group of 21,222 patients, the wait times for screens decreased by almost 90 percent, and overall screening rates for diabetic retinopathy increased 16 percent. The digital program also eliminated the need for 14,000 visits to specialty care professionals.
First, LADHS certified medical assistants were trained to use retinal cameras at a primary care setting. They took and uploaded photos to the web-based screening software, then handed it over to LADHS optometrists, who read the images and provided follow-up recommendations back to the primary care professionals within the web portal. If the results were normal, the primary care physicians could handle it without the need to refer patients to a specialist, which was the case 69 percent of the time in this study. Those who had more concerning results would be referred to either an optometrist or ophthalmologist, depending on the severity of their condition.
A big gain was in the sheer number of patients who got screenings in the first place and the reduction in wait time. Prior to the telemedicine approach, the median wait time for a screening was more than five months. With the technology, patients could get a screening with their primary care physician within about two weeks. And since a specialist wasn't required to perform the screening, specialists were able to focus their time and efforts on the patients who needed them the most.
“By eliminating the need for a separate visit to a specialist, we are able to increase the number of patients screened for DR without increasing demand on specialty care,” Dr. Lauren P. Daskivich, lead author of the study and director of ophthalmology and eye health programs at LADHS, said in a statement. “Most importantly this frees up specialist time for follow-up on abnormal screening results. By facilitating communication and maximizing scheduling access, eConsult plays a significant role in how we create capacity and sustainably provide coordinated care for patients with DR across all of the LADHS sites.”