Virtual clinics in glaucoma care: face-to-face versus remote decision-making

• Published in: British journal of ophthalmology Vol. 101; no. 7; pp. 892 - 895
• Main Authors: Clarke, Jonathan, Puertas, Renata, Kotecha, Aachal, Foster, Paul J, Barton, Keith
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.07.2017; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Appointments & personnel changes; Appointments and Schedules; Audit departments; Chronic illnesses; Clinical decision making; Clinical science; Clinics; Data collection; Decision Making; Diagnostic tests/Investigation; Female; Follow-Up Studies; Funding; Glaucoma; Glaucoma - diagnosis; Hospitals; Humans; Hypertension; Male; Medical diagnosis; Methods; Middle Aged; Ophthalmology; Ophthalmology - methods; Outpatient Clinics, Hospital - organization & administration; Patients; Prospective Studies; Referral and Consultation; ROC Curve; Telemedicine; Time Factors; United Kingdom > UK; Glaucoma; Telemedicine; Diagnostic tests/Investigation
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2016-308993

Background/aimsTo examine the agreement in clinical decisions of glaucoma status made in a virtual glaucoma clinic with those made during a face-to-face consultation.MethodsA 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.ResultsWe 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).ConclusionsThe 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.