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Teleophthalmology Support for Primary Care Diagnosis and Management

Elmar Torres, Paulo H. Morales, Olimpio J.N.V. Bittar, Nacime S. Mansur, Solange R. Salomão, Rubens Belfort Jr

Abstract


To evaluate a healthcare strategy based on teleophthalmology for diagnosing and managing primary healthcare users this study has been performed.

We conducted a descriptive cross-sectional study to review the medical records of patients from January 2013 to December 2014 from primary care units in the city of São Paulo. The units referred patients for a fundus examination who had diabetes, high blood pressure, and were users of chloroquine compounds. The images were sent to a reading center for review, diagnosis, and patient referrals.

Of 9,173 analyzed patients, 570 (6.2%) were excluded because of poor image quality. Of the remaining patients, 4,933 (57.3%) had diabetes, 7,242 (84,2%) systemic hypertension, and 113 (1.3%) used chloroquine. Of these, 989 (11.5%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in 692 (70%) of 989 and photocoagulation in 245 (24.8%)of 989. Of the total, cataract extraction was indicated in 692 (8%) of 8,603 cases and photocoagulation in 245 (2.8%) of 8,603 cases. When we considered only patients with diabetes, the indication for photocoagulation rose to 4.5%.

The results showed that non-medical professionals can produce good-quality ocular images for screening of ocular diseases in most cases; only 6.2% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive reliable tool for use in developing countries.




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