JMIR Publications

ABSTRACT

Background:

Many patients attending hospital emergency services with recent-onset eye symptoms could have been managed in the community. This may reflect a lack of specialist experience or triage capacity among primary care providers. Online triage tools collect patient symptomatology and relevant ophthalmic and medical history virtually, compile a report and suggest an outcome decision which can support the streaming and direction of patients to a suitable service within an appropriate timeframe.

Objective:

Our objectives were to survey the opinions of community optometrists regarding current triage practices, and to implement and analyse real-world use of a novel online triage tool in a community optometry setting.

Methods:

This was a real-world mixed methods evaluation of a web-application (app) “eye+dot” which uses a conditional logic multiple-choice questionnaire to produce a symptom report and automated triage recommendation. A pre-implementation survey was used to gather views regarding current triage practices and interest in trialling an online triage tool among community optometrists. The app was then implemented in participating practices, with optometrists receiving the symptom report but not the automated triage disposition. The accuracy of optometrists and the app in identifying urgent cases (needing specialist examination within 24 hours) was compared to a gold standard, generated by retrospective review of the symptom reports by hospital specialists. Metadata including patient age, test duration and usability feedback were analysed.

Results:

Seven optometry practices trialled the app over 5 months. Records of 211 patients with mean age 53.5 years (range 13 – 90, SD 17.5) were analysed. Three patients with potentially sight or life-threatening symptoms (as defined by Royal College of Ophthalmologists guidelines) received appropriate urgent hospital dispositions by both optometrists and eye+dot. The app’s automated disposition had similar sensitivity as optometry triage (75.5% versus 77.3% respectively, P = .99) but significantly better specificity (82.7% versus 54.4%, P < .001) for identification of the 53 cases categorised as requiring either hospital or community specialist examination within 24 hours by gold-standard review. 147 patients gave acceptability feedback, with 121 (82.3%) of them giving a rating in the top 2 points of a 5-point visual Likert scale. Optometrists in 5 of the 7 practices found the app helpful and were interested in continuing its use.

Conclusions:

This real-world study demonstrates the triage tool’s accuracy for identifying high risk symptomatology and its acceptability among patients and optometry services. The significantly lower optometric triage specificity may reflect risk-averse decision making following direct communication with patients and appointment availability in primary care. In addition, the relatively low mean age of patients suggests possible barriers to uptake among older patients. This and other symptom-based triage tools can provide useful support to eyecare providers in the community where access to specialist triage may be limited.