Can smart phone fundoscopy enhance family care in Singapore?

Problem

Singapore has a 'War on Diabetes'. There are well developed eye screening programs but compliance is suboptimal, particularly for patients of private GPs who have to travel to another center for their eye examinations. We wondered whether there was potential for fundoscopy using a small smart phone attachment to improve patient care?

Approach

One to one in depth interviews with 20 Family Doctors working in a variety of settings (solo general practice, group practice and polyclinics). The were able to handle the device and were shown a video on how it can be used. Verbatim transcription and content analysis of interview were undertaken by all the project team.

Findings

For most respondents this was their first encounter with the technology, but some had familiarised themselves with the technology so that they did not appear ignorant, ‘As I said, I don’t want to look totally daft, so before he [interviewer] comes I better read what the heck this is.' Response to the device were far ranging, from ‘It’s a great device. I love it’ to complete dismissal ‘For me it’s a total no’ . Some described how their impressions shifted during the interview ‘Well before I …. before I tried it out, I .. I…I was sceptical that something you could put onto the phone and then how you view the retina accurately. Reservations related to unfamiliarity with handling, inability to interpret images oneself, patients thinking it was 'a toy' rather than a piece of medical equipment. Advantages: reducing unnecessary ophthalmology referrals, improved compliance with fundoscopy, ability to use on home visits, teaching and assessing students, increasing quality of eye examination, one stop care, ability to share images with patients to motivate lifestyle changes.

Consequences

Respondents described the utility if the device in one of three ways, unnecessary (given the existing service configuration), useful to augment existing facilities or as a potential replacement to the fundoscopy service for patients with diabetes.