Clarke, J;
Puertas, R;
Kotecha, A;
Foster, PJ;
Barton, K;
(2017)
Virtual clinics in glaucoma care: face-to-face versus remote decision-making.
British Journal of Ophthalmology
, 101
(7)
pp. 892-895.
10.1136/bjophthalmol-2016-308993.
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Abstract
BACKGROUND/AIMS: To examine the agreement in clinical decisions of glaucoma status made in a virtual glaucoma clinic with those made during a face-to-face consultation. METHODS: A trained nurse and technicians entered data prospectively for 204 patients into a proforma. A subsequent face-to-face clinical assessment was completed by either a glaucoma consultant or fellow. Proformas were reviewed remotely by one of two additional glaucoma consultants, and 12 months later, by the clinicians who had undertaken the original clinical examination. The interobserver and intraobserver decision-making agreements of virtual assessment versus standard care were calculated. RESULTS: We identified adverse disagreement between face-to-face and virtual review in 7/204 (3.4%, 95% CI 0.9% to 5.9%) patients, where virtual review failed to predict a need to accelerated follow-up identified in face-to-face review. Misclassification events were rare, occurring in 1.9% (95% CI 0.3% to 3.8%) of assessments. Interobserver κ (95% CI) showed only fair agreement (0.24 (0.04 to 0.43)); this improved to moderate agreement when only consultant decisions were compared against each other (κ=0.41 (0.16 to 0.65)). The intraobserver agreement κ (95% CI) for the consultant was 0.274 (0.073 to 0.476), and that for the fellow was 0.264 (0.031 to 0.497). CONCLUSIONS: The low rate of adverse misclassification, combined with the slowly progressive nature of most glaucoma, and the fact that patients will all be regularly reassessed, suggests that virtual clinics offer a safe, logistically viable option for selected patients with glaucoma.
| Type: | Article |
|---|---|
| Title: | Virtual clinics in glaucoma care: face-to-face versus remote decision-making |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bjophthalmol-2016-308993 |
| Publisher version: | http://doi.org/10.1136/bjophthalmol-2016-308993 |
| Language: | English |
| Additional information: | This article has been accepted for publication in the British Journal of Ophthalmology following peer review. The definitive copyedited, typeset version, Clarke, J; Puertas, R; Kotecha, A; Foster, PJ; Barton, K; (2016) Virtual clinics in glaucoma care: face-to-face versus remote decision-making. British Journal of Ophthalmology, is available online at: http://dx.doi.org/10.1136/bjophthalmol-2016-308993. |
| Keywords: | Diagnostic tests/Investigation, Glaucoma, Telemedicine |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1524250 |
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