Even before COVID-19, telemedicine was on the rise. In accordance with this trend, a recent study suggests a substantial portion of diabetic patients can be initially managed through a virtual visit. Specifically, the research team from the United Kingdom and Switzerland found that nearly three-quarters of all patients initially seen in a clinic qualified for a virtual consultation based on their retinopathy level and visual function. Despite this finding, however, only 26% of the 8,833 patients who qualified for a virtual appointment received one due to capacity constraints.

The retrospective cohort study included 12,563 diabetic patients referred for either a virtual or traditional doctor’s appointment.

In terms of efficiency, patients who were referred to virtual clinics were able to attend their first hospital eye service appointment about two weeks sooner than if they were triaged to a clinic for a face-to-face visit. Consequently, the time to clinical decision was also faster for these patients. As such, patients who didn’t require secondary care spent less time in the hospital eye service when managed in a virtual clinic. This improvement in efficiency did not adversely affect patient safety, the investigators said.

For routine referrals, the approximate time of the first hospital appointment was about 70 days and 81 days for virtual and face-to-face consultations, respectively. The time from referral to discharge was 71.7 days and 86.3 days for virtual and face-to-face consultations, respectively.

Additionally, there was no major difference in time-to-treatment in a subcohort that required intravitreal therapy for maculopathy (virtual clinics: 220.7 days; face-to-face: 178 days).

No-show rates for both in-person and virtual appointments were about the same, at 32% and 28%, respectively.

Increasing the adoption of virtual clinics in the management of diabetic patients that do not need long-term management or monitoring for secondary care may help alleviate service demands without diminishing the quality of clinical care, the researchers explained. “Collectively, our analyses suggest that virtual consultations are a faster and clinically appropriate alternative for a substantial proportion of diabetic patients,” the investigators wrote in their paper.

Faes L, Fu DJ, Huemer J, et al. A virtual-clinic pathway for patients referred from a national diabetes eye screening program reduces service demands whilst maintaining quality of care. Eye (Lond). October 30, 2020. [Epub ahead of print].