[Analysis of telemedicine applications in the management-coordination of specialized and primary care. Appraisal of results and costs of pre-existing experiences (teleophthalmology)]

Orruno Aguado E, Lapuente Troncoso JL, Gutierrez Iglesias A, Asua Batarrita J
Record ID 32008100083
Original Title: Análisis de la introducción de la Telemedicina en la gestión-coordinación de atención primaria-especializada. Evaluación de resultados y costes de experiencias preexistentes (teleoftalmología)
Authors' objectives: 1. Assessment of the efficiency of telemedicine systems in the interaction between primary and specialist healthcare. 2. Analysis and determination of the resources required to implement telemedicine technologies with proven efficiency, adapted to the environment of the Basque Autonomous Community. 3. Assessment of the results and quality of the processes developed in specific experiences implemented in our environment. 4. Economic assessment of the different alternatives available for implementing these systems.
Authors' results and conclusions: The articles reviewed with level I evidence indicate that the use of digital images of one or two fields by means of telemedicine has acceptably high levels of sensitivity and specificity for the detection of diabetic retinopathy. The scientific literature reviewed confirms the suitability of the digital camera as the screening method for diabetic retinopathy as the sensitivity and specificity values reached for this technique come close to the Saint Vincent criteria (80% of sensitivity and 95% specificity). According to the reviewed literature, the use of the digital image through telemedicine is at least as accurate as ophthalmoscopy performed by an experienced ophthalmologist for the detection of diabetic retinopathy. All the studies that include satisfaction results considered in this review seem to indicate that both patients and healthcare professionals show a high level of satisfaction with the healthcare provided through telemedicine. The digital non-midriatic method is e0.66 cheaper per patient than the indirect ophthalmoscope. For the patient, the digital non-midriatic camera involves shorter waiting times as compared to the traditional ophthalmoscope as in most cases it is not necessary to administer pupil dilating drugs. The digital non-midriatic camera only causes temporary incapacitation in 6.25% of cases due to the effect of the drug administered, while the ophthalmoscope causes incapacitation in 100% of the cases. For the optimistic scenario, the study shows a saving of e1.57 per patient in the case of the digital non-midriatic camera compared to the traditional ophthalmoscope. Nevertheless, for the pessimistic scenario, the traditional ophthalmoscope is e0.70 cheaper per patient than the digital camera. In comparison with the current scenario, in which the digital non-midriatic camera is used on an exclusive basis and in which 90% of patients are diagnosed by means of the digital non-midriatic retinograph, this represents a cost saving of e9,951.11 and e8,690.64, respectively. The payback period of the cost of acquiring the digital fundus camera is 2.92 years and 3.35 years according to the scenarios analysed.
Authors' methods: Systematic review of the literature and summary of evidence of the effectiveness of telemedicine for the diagnosis and treatment of eye diseases (including diabetic retinopathy) as well as an analysis of the level of satisfaction of patients and professionals through the use of questionnaires. Analysis and comparison of the costs of the alternatives studied.
Project Status: Completed
Year Published: 2008
English language abstract: An English language summary is available
Publication Type: Mini HTA
Country: Spain
MeSH Terms
  • Telemedicine
  • Diabetic Retinopathy
  • Ophthalmology
  • Health Resources
  • Resource Allocation
  • Quality of Health Care
  • Interinstitutional Relations
  • Relaciones Interinstitucionales
  • Calidad de la Atención Sanitaria
  • Asignación de Recursos
  • Recursos Sanitarios
  • Oftalmología
  • Retinopatía Diabética
  • Telemedicina
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.