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Clinical staff impressions on implementation of a teleophthalmology program to improve diabetic retinopathy surveillance informed by implementation science frameworks (Preprint)


 BACKGROUND
 Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow.
 
 
 OBJECTIVE
 Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption.
 
 
 METHODS
 This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks.
 
 
 RESULTS
 Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability.
 
 
 CONCLUSIONS
 Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.
