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

Jonathan Clarke, Renata Puertas, Aachal Kotecha, Paul J Foster, Keith Barton
2016 British Journal of Ophthalmology  
Synopsis The study demonstrates that virtual decision making, by senior medical staff, for stable glaucoma has reasonable agreement with face to face clinical decisions. There are no significant safety issues with virtual clinics. 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
more » ... 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 inter-observer and intra-observer decision making agreement 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%, 5.9%) patients, where virtual review failed to predict a need to accelerated follow-up identified in face to face review. Mis-classification events were rare, occurring in 1.9% (95% CI: 0.3% and 3.8%) of assessments. Inter-observer kappa [95% confidence intervals; 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 (k = 0.41 [0.16 to 0.65]). The intra-observer agreement kappa [95% CI] for the consultant was 0.274 [0.073 to 0.476], and for the fellow was 0.264 [0.031 to 0.497]. Conclusion: The low rate of adverse mis-classification, 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 glaucoma patients.
doi:10.1136/bjophthalmol-2016-308993 pmid:27729310 fatcat:4w2hok2azjbsfhx2egze23in5q