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Faes, Livia; Fu, Dun Jack; Huemer, Josef; Kern, Christoph; Wagner, Siegfried K.; Fasolo, Sandro; Hamilton, Robin; Egan, Catherine; Balaskas, Konstantinos; Keane, Pearse A.; Bachmann, Lucas M.; Sim, Dawn A. (2020): A virtual-clinic pathway for patients referred from a national diabetes eye screening programme reduces service demands whilst maintaining quality of care. In: Eye, Vol. 35, No. 8: pp. 2260-2269
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Aim: To evaluate the potential of an integrated virtual medical retina clinic in secondary care for diabetic patients screened and referred by the UK National Diabetic Eye Screening Program (DESP). Methods This retrospective cohort study included diabetic patients referred by the DESP to either a virtual or a traditional doctor's appointment (face-to-face, F2F) at the Moorfields Eye Hospital NHS Foundation Trust (London, UK) between January 2015 and December 2018. The primary outcome was the proportion of patients that qualified for a virtual-clinic appointment according to hospital guidance. Secondary outcomes included the rate of attendance, mean time from DESP referral to initial hospital appointment, mean time-to-discharge and -to-treatment of either panretinal photocoagulation or intravitreal injection of anti-vascular endothelial growth factor. Results We included 12,563 patients in this study. While 8833 patients (70.7%) would have qualified for a virtual appointment according to local triage guidance, only 2306 (18.4%) were referred to a virtual consultation due to capacity constraints. For routine referrals, mean time to the first hospital appointment was 66.9 days with a standard deviation of +/- 35.9 and 80.9 +/- 44.4 days for a virtual and a F2F consultation, respectively. The mean time from referral to discharge to community was 71.7 +/- 30.8 and 86.3 +/- 37.0 days for a virtual and a F2F consultation, respectively. We did not observe a statistically significant difference in the mean time-to-treatment in the sub-cohort that required intravitreal therapy for maculopathy (virtual clinics: 220.7 +/- 84.8;F2F: 178.0 days +/- 80.7;p value > 0.05). Moreover, we observed a non-inferior attendance rate in virtual as compared to F2F clinics. Conclusion A significant proportion of diabetic patients referred to a F2F clinic could initially be managed in a virtual clinic. Increasing the adoption of virtual clinics in the management of diabetic patients that do not need long-term management or monitoring in secondary services may help alleviate service demands without diminishing quality of clinical care. Collectively, our analyses suggest that virtual consultations are a faster and clinically appropriate alternative for a substantial proportion of diabetic patients.