Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy

PLoS One. 2021 Nov 30;16(11):e0260594. doi: 10.1371/journal.pone.0260594. eCollection 2021.

Abstract

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Eye Diseases / diagnosis*
  • Female
  • Humans
  • Intraocular Pressure*
  • Male
  • Middle Aged
  • Nursing Staff*
  • Ophthalmologists*
  • Ophthalmology
  • Primary Health Care
  • Telemedicine*
  • Tonometry, Ocular*

Grants and funding

This work is based on research supported by Hospital Moinhos de Vento and the Program of Support for the Institutional Development of the Unified Health System (PROADI-SUS) (Website: http://www.saude.gov.br/acoes-e-programas/proadi-sus). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.