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January 7, 2021

Express Medicine—Potential for Home-Based Medical Care

Author Affiliations
  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • 2Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Editor, JAMA Ophthalmology
JAMA Ophthalmol. 2021;139(3):269-270. doi:10.1001/jamaophthalmol.2020.5981

The express industry provides door-to-door deliveries of goods (eg, DHL or FedEx) or services (eg, visiting nurse care or mobile nail salons). These industries have made life potentially easier and more convenient, in that people can get goods or services without leaving home. Their use also has expanded throughout the world, even in areas where such services previously were not popular.1 As coronavirus disease 2019 (COVID-19) has catalyzed the incorporation of telemedicine into ophthalmic care,2 the field seems ready to expand into home monitoring of ophthalmic diseases, such as the neovascular form of age-related macular degeneration (nAMD) or diabetic macular edema. Managing these conditions may involve millions of office monitoring visits. However, if research shows that some monitoring of visual acuity and structural changes in the macula can be done from the home to determine when office visits are needed for evaluation or treatment, without sacrificing visual acuity outcomes, or to even provide treatment, such as an intravitreous injection in the home by a qualified health care professional, then such monitoring may transform current ophthalmic care not only during a pandemic but thereafter, especially if accompanied by reduced costs, improved utilization of services, and greater patient satisfaction. The approach also might have applications in assisted living or nursing home environments.

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    1 Comment for this article
    Data Quality and Decision-Precision in Express Medicine
    Peter Shah, BSc FRCOphth FRCP Edin MA | University Hospitals Birmingham NHS Foundation Trust
    Yizhi Liu, Yingfeng Zheng and Neil Bressler comprehensively discuss the possibilities and challenges of a potential shift towards 'express medicine' and home-based care. Any efforts to enhance the self-care of our patients must be welcomed. However, the authors are right to focus on the importance of regulation in the development of this new technology.

    Data quality must be at the heart of these next steps - poor data inputs lead to reduced precision of clinical decisions, with the potential for both clinical inefficiency and clinical harm. Ensuring data quality as data collection moves between geographical and socioeconomic sectors
    will prove challenging, but offers the potential to reduce some of the barriers afforded by social inequity.