Assessment of Patients' Confidence Regarding a New Triage Concept in a Medical Retina Clinic during the First COVID-19 Outbreak

Abstract

Background: During the first COVID-19 pandemic outbreak, a new triage concept had to be implemented for patients with retinal diseases having a scheduled appointment at the medical retina clinic. In this study, we aimed to assess patients' confidence in this triage concept and patients' satisfaction regarding the received treatment during the outbreak.

Methods: This retrospective study included all patients with a diagnosed retinal disease, triaged into three priority groups based on their condition's urgency during lockdown. After restrictions were eased, a subset of previously triaged patients was interviewed to assess their confidence in the triage and their satisfaction regarding the received treatment during the pandemic.

Results: In total, 743 patients were triaged during the lockdown. Over 80% received an urgent appointment (priority 1). Among all priority 1 patients, over 84% attended their appointment and 77% received an intravitreal injection (IVI), while 7% cancelled their appointment due to COVID-19. In post-lockdown interviews of 254 patients, 90% trusted the emergency regimen and received treatment.

Conclusions: Our triage seemed to be useful in optimizing access to treatment for patients with retinal diseases. An excellent rating of patients' confidence in the triage and satisfaction regarding the received treatment during the first COVID-19 outbreak could be achieved.

Keywords: COVID-19 outbreak; age-related macular degeneration; anti-VEGF; diabetic macular edema; emergency regime; eye care; intravitreal injection; patients’ confidence; retinal vein occlusion; triage.

Figure 1

Flowchart outlining the triage used at the medical retina clinic, Department of Ophthalmology, University Hospital of Zurich. Each square contains the number of patients and further descriptions for each group.

Figure 2

Primary ophthalmic diseases of the interviewed study participants. The graph shows the number of patients in each group followed by its percentage among all primary ophthalmic diseases. Abbreviations: nAMD: neovascular age-related macular degeneration; BRVO: branch retinal vein occlusion; CRVO: central retinal vein occlusion; Myopic CNV: myopic choroidal neovascularization; Secondary CNV: secondary choroidal neovascularization, other than AMD or myopia-related; DME: diabetic macular edema; NPDR: non-proliferative diabetic retinopathy; PDR: proliferative diabetic retinopathy.

Figure 3

Results from the Visual Field Questionnaire—25 (VFQ-25) assessments. Answers to the questions, “In general, would you say your overall health is:”, “At the present time, would you say your eyesight using both eyes (with glasses or contact lenses, if you wear them) is excellent, good, fair, poor or very poor or are you completely blind?” and “How much of the time do you worry about your eyesight?” Results for each bar are shown in absolute numbers and percentages.

Figure 4

Results from the additional questionnaire assessments. Answers to the questions “Do you think that the eye clinic took sufficient consideration of your eye disease during the COVID-19 pandemic?”, “Do you feel confident about the emergency concepts employed by the eye clinic?”, “If you were treated during the COVID-19 lockdown, how did you feel about the fact that you were treated?” Results for each bar are shown in absolute numbers and percentages.

Figure 5

ANOVA analysis of the best corrected visual acuity of the right eye (BCVA.OD) with ETDRS letter scores in comparison with their self-estimated visual acuity from the answer to the question “At the present time, would you say your eyesight using both eyes (with glasses or contact lenses, if you wear them) is excellent, good, fair, poor or very poor or are you completely blind?” Error bars with ± 2 standard errors.