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Abstract：
BACKGROUND: This study aimed to determine whether teleretinal screening for hydroxychloroquine retinopathy (HCQR) improves clinical efficiency and adherence to recommended screening guidelines compared to face-to-face screening among patients in a large safety net medical system.
METHODS: In this retrospective cohort study of a consecutive sample of 590 adult patients with active HCQ prescriptions seen in the outpatient ophthalmology clinic at Los Angeles County + University of Southern California Medical Center from 1 September 2018 to 25 November 2019, 203 patients underwent technician-only tele-HCQR screening (THRS), and 387 patients underwent screening with traditional face-to-face visits (F2FV) with an eye-care provider. Data on clinic efficiency measures (appointment wait time and encounter duration) and adherence to recommended screening guidelines were collected and compared between the two cohorts.
RESULTS: Compared to F2FV, the THRS cohort experienced significantly shorter median (interquartile range) time to appointment (2.5 (1.5-4.6) vs. 5.1 (2.9-8.4) months; p < 0.0001), shorter median encounter duration (1 (0.8-1.4) vs. 3.7 (2.5-5.2) hours; p < 0.0001) and higher proportion of complete baseline screening (102/104 (98.1%) vs. 68/141 (48.2%); p < 0.001) and complete chronic screening (98/99 (99%) vs. 144/246 (58.5%); p < 0.001).
CONCLUSIONS: A pilot THRS protocol was successfully implemented at a major safety net eye clinic in Los Angeles County, resulting in a 50.9% reduction in wait times for screening, 72.9% reduction in encounter duration and 49.9% and 40.5% increases in proportions of complete baseline and chronic screening, respectively. Tele-HCQ retinal screening protocols may improve timeliness to care and screening adherence for HCQR in the safety net setting.
METHODS: In this retrospective cohort study of a consecutive sample of 590 adult patients with active HCQ prescriptions seen in the outpatient ophthalmology clinic at Los Angeles County + University of Southern California Medical Center from 1 September 2018 to 25 November 2019, 203 patients underwent technician-only tele-HCQR screening (THRS), and 387 patients underwent screening with traditional face-to-face visits (F2FV) with an eye-care provider. Data on clinic efficiency measures (appointment wait time and encounter duration) and adherence to recommended screening guidelines were collected and compared between the two cohorts.
RESULTS: Compared to F2FV, the THRS cohort experienced significantly shorter median (interquartile range) time to appointment (2.5 (1.5-4.6) vs. 5.1 (2.9-8.4) months; p < 0.0001), shorter median encounter duration (1 (0.8-1.4) vs. 3.7 (2.5-5.2) hours; p < 0.0001) and higher proportion of complete baseline screening (102/104 (98.1%) vs. 68/141 (48.2%); p < 0.001) and complete chronic screening (98/99 (99%) vs. 144/246 (58.5%); p < 0.001).
CONCLUSIONS: A pilot THRS protocol was successfully implemented at a major safety net eye clinic in Los Angeles County, resulting in a 50.9% reduction in wait times for screening, 72.9% reduction in encounter duration and 49.9% and 40.5% increases in proportions of complete baseline and chronic screening, respectively. Tele-HCQ retinal screening protocols may improve timeliness to care and screening adherence for HCQR in the safety net setting.
摘要：
背景：本研究旨在确定与大型安全网医疗系统中的患者面对面筛查相比，远端筛查羟氯喹视网膜病变（HCQR）是否能提高临床效率和对推荐筛查指南的依从性。
方法：在这项回顾性队列研究中，从2018年9月1日至2019年11月25日，在洛杉矶县+南加州大学医学中心的门诊眼科诊所中观察到590名使用活性HCQ处方的成年患者，203名患者接受了仅技术人员的远程HCQR筛查（THRS）。387例患者接受了眼科护理提供者的传统面对面访视(F2FV)筛查.收集有关临床效率测量（预约等待时间和相遇持续时间）和对推荐筛查指南的依从性的数据，并在两个队列之间进行比较。
结果：与F2FV相比，THRS队列经历了显著缩短的中位数（四分位数间距）时间（2.5（1.5-4.6）与5.1（2.9-8.4）个月；p<0.0001），较短的中值相遇持续时间（1（0.8-1.4）与3.7（2.5-5.2）小时；p<0.0001），完全基线筛查的比例更高（102/104（98.1％）与68/141（48.2％）；p<0.001）和完全慢性筛查（98/99（99％）与144/246（58.5%）；p<0.001）。
结论：在洛杉矶县的主要安全网眼科诊所成功实施了一项试点THRS协议，导致筛查等待时间减少50.9%，接触持续时间减少72.9％，完全基线和慢性筛查比例增加49.9％和40.5％，分别。远程HCQ视网膜筛查方案可以提高在安全网设置中HCQR的护理和筛查依从性的及时性。
方法：在这项回顾性队列研究中，从2018年9月1日至2019年11月25日，在洛杉矶县+南加州大学医学中心的门诊眼科诊所中观察到590名使用活性HCQ处方的成年患者，203名患者接受了仅技术人员的远程HCQR筛查（THRS）。387例患者接受了眼科护理提供者的传统面对面访视(F2FV)筛查.收集有关临床效率测量（预约等待时间和相遇持续时间）和对推荐筛查指南的依从性的数据，并在两个队列之间进行比较。
结果：与F2FV相比，THRS队列经历了显著缩短的中位数（四分位数间距）时间（2.5（1.5-4.6）与5.1（2.9-8.4）个月；p<0.0001），较短的中值相遇持续时间（1（0.8-1.4）与3.7（2.5-5.2）小时；p<0.0001），完全基线筛查的比例更高（102/104（98.1％）与68/141（48.2％）；p<0.001）和完全慢性筛查（98/99（99％）与144/246（58.5%）；p<0.001）。
结论：在洛杉矶县的主要安全网眼科诊所成功实施了一项试点THRS协议，导致筛查等待时间减少50.9%，接触持续时间减少72.9％，完全基线和慢性筛查比例增加49.9％和40.5％，分别。远程HCQ视网膜筛查方案可以提高在安全网设置中HCQR的护理和筛查依从性的及时性。
