a platform that will accommodate the care for population health and high risk homebound groups . Taking a different approach from " Build it and they will come ", MD24 GTN is using the focus group method to understand the difficulties from providers while using a telemedicine platform , and combining with the needs of patients to provide the solution for quality care . Through the network of our partners , including Independent Physician Associations , insurance plans , and healthcare systems , MD24 GTN brings in valuable benefits to the current practice . They all have exclusive networks of physicians and patients , both of whom will benefit from our robust platform . The interactive platform allows patients to experience a new way of taking care of their health at their convenience anywhere , even from home .
6 . Factors that Affect Computer-assisted Diagnosis Supporting Teleretinal Consultations
Jorge Cuadros , OD , PhD 1 , 2 , Carolyn Smith-Morris , PhD , MS , LPC 3 , Kathryn Bouskill , PhD 2 , George Bresnick MD , MPA 1 , 2
1 University of California , Berkeley , 2 EyePACS LLC , 3 Southern Methodist University
Background : Teleretinal programs ( TR ) have been performed successfully on millions of patients with diabetes . Computer assisted diagnosis ( CAD ) has been developed for automated detection of retinal disease , and provides accurate and immediate results that can be used for triage of patients to treatment . Adherence with TR recommendations for timely treatment is low , however , and treatment is often delayed until symptoms arise and successful outcomes are much less likely . This study identifies key factors that influence patient adherence and will guide the development of new features in TR , including CAD .
Methods : Two ethnographers and one computer-human interface expert along with the EyePACS research team interviewed 24 patients and 24 staff members in three clinics that use TR . The interviews focused on referral processes and adherence with treatment plans .
Results : Most patients who are referred for treatment from TR are not being treated in a timely manner : 1 . Substantial barriers exist in scheduling follow-up appointments from TR visits . 2 . Failure to integrate TR results into Primary Care is linked with inadequate communication and support of referred patients . 3 . Patient education is considered important but is not supported in the TR process . 4 . Cultural , religious , and social factors greatly influence patient decisions about treatment . 5 . Comorbidities also influence patient decisions about eye treatment when patients see well . 6 . Social isolation is both a cause and outcome of poor health and is not addressed by TR .
Conclusion : While teleretinal programs continue to grow , development must be focused on targeting the right individuals and enhancing and supporting follow through with live medical care . CAD may improve follow through if it is developed in a way that supports the referral process and engages patients .
7 . Novel e-Health Intervention for Panic Disorder : Functional Improvement and Patient Compliance Robert N . Cuyler , PhD Palo Alto Health Sciences
Background : Panic disorder is a common and debilitating condition that produces terrifying symptoms such as chest pain , shortness of breath , fear of dying or losing control . Consequences include social and job impairment , excess medical spending , and development of agoraphobia , depression and substance use disorders . Current first line treatments include medication and therapy but each has significant limitations . Treatment drop-out is common in both . Palo Alto Health Sciences offers the Freespira Breathing System , an FDA-cleared intervention for treatment of panic that teaches clients to modify the dysfunctional breathing patterns characteristic of panic sufferers . The intervention is an e-health intervention that is practiced twice daily at home for one month . Initial client training can be given either in person or via secure telehealth . Data are uploaded to the company ’ s secure server following each session , so that client adherence and progress is available asynchronously to the clinician .
Methods : Recent clinical trials provided Freespira ’ s capnometry-assisted breathing training to subjects with panic disorder and measured baseline and post-treatment functioning . This poster presents discontinuation and adherence data on clinical trials subjects as well as from routine clinical practice . In addition , a subset of clinical trials subjects showing the most severe functional impairment were assessed using the Sheehan Disability Scale score at baseline and one year posttreatment .
Results : Treatment discontinuation rates were 20 % or below , while 87 % of clients completed the recommended course of treatment . Sheehan Disability Scale scores showed clinically and statistically significant decreases .
Conclusions : The majority of clients use the device as directed and have low rates of discontinuation . Additionally , remote monitoring capability promotes compliance and benefit . Data reflect rapid and significant decrease in functional impairment . The significant reductions in disruption of work / school function , social activities , and family / home responsibilities may reduce the impact of this disorder on quality of life and productivity and decrease medical costs .
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