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Original Investigation | Journal Club

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

Lauren Wedekind1,2; Kristin Sainani, PhD3; Suzann Pershing, MD, MS1,4
[+] Author Affiliations
1Department of Ophthalmology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
2Department of Human Biology, Stanford University, Stanford, California
3Department of Health Research and Policy, Stanford University, Stanford, California
4Byers Eye Institute at Stanford University, Palo Alto, California
JAMA Ophthalmol. 2016;134(5):537-543. doi:10.1001/jamaophthalmol.2016.0316.
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Importance  Determining the perceived supply and potential demand for teleophthalmology in emergency departments could help mitigate coverage gaps in emergency ophthalmic care.

Objective  To evaluate the perceived current need for and availability of ophthalmologist coverage in California emergency departments and the potential effect of telemedicine for ophthalmology triage and consultation.

Design, Setting, and Participants  Surveys were remotely administered to 187 of the 254 emergency departments throughout California via the telephone and Internet from June 30 to September 23, 2014. Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development database were individually surveyed to assess facility characteristics and resources as well as the perceived usefulness of teleophthalmology consultation. Data analysis was conducted from June 30, 2014, to March 11, 2015.

Main Outcomes and Measures  Perceived availability of ophthalmology consultation coverage and perceived effect of telemedicine ophthalmology consultation at each facility.

Results  Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported availability of emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). Rural facilities reported a mean (SD) of 23.72 (14.15) miles between the facility and referral location, while nonrural facilities reported a mean of 4.41 (10.23) miles (19.3% difference). On a scale of 1 to 5 (where 1 signifies very low value and 5 signifies very high value), 124 of 187 nurse managers (66.3%) and 80 of 121 physicians (66.1%) rated teleophthalmology as having high or very high value for triage purposes. The most frequently cited potential advantage of emergency teleophthalmology was assistance in patient triage and immediate real-time electronic communication, and the most frequently cited potential disadvantages were unknown cost of contracting and maintenance and concern that eye trauma might make photographs or videos less conclusive.

Conclusions and Relevance  Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation. Overall, the study suggests that teleophthalmology could play a role in mitigating coverage gaps in emergency ophthalmic care and could be further investigated through similar studies in other regions.

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