Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic

Abstract

IMPORTANCE Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed.OBJECTIVE To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included. EXPOSURES Telemedicine vs in-person clinical encounters. MAIN OUTCOMES AND MEASURESVariables associated with use of ophthalmic telemedicine during the study period.RESULTS A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone-and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23). CONCLUSIONS AND RELEVANCEThe findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.

Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System

“…Taken together, these findings are consistent with existing studies demonstrating that patients that preferentially used EDs for care over telehealth during the early COVID surge were more likely to belong to minority populations (10,24). Reassuringly consistent with a recent study, (27) these groups were also wellrepresented among patients that had one or more office visits during the pandemic period, suggesting that despite lower TN utilization, populations that are historically affected by health disparities may have been able to preserve their access to their neurological providers through in-person, office encounters (Supplementary Table 3).…”

“…Furthermore, two of the aforementioned studies were conducted in urban tertiary-care settings similar to ours, (5,17) lending further credence to the generalizability of our results. Similar studies in non-neurological populations (10,(22)(23)(24)(25)(26)(27)(28) have shown consistent results with ours, with one study from a large urban health system demonstrating that socially vulnerable populations were more likely to use ED care and office visits in favor of telemedicine care (10). It is interesting to note that multiple studies conducted prior to the COVID-19 pandemic have found that minority status was associated with increased odds of telemedicine utilization in comparison to White patient groups, (29)(30)(31) suggesting that our findings may be in part related to the extraordinary nature of the COVID-19 public health emergency.…”

Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital

“…Discrepancies between previous findings underscore familiar challenges associated with implementing new care innovations and the importance of diversity and inclusion during early design and evaluation phases. Compared to prior studies with low proportions of Hispanic patients (for example, 1.2% in study by Aziz et al) [ 31 ], one primary strength of our study was the inclusion of a Hispanic population that was representative of our geographic region (11.1% vs. 10.7% in North Carolina) [ 32 ]—strengthening the applicability of our findings to the overall population from which the study cohort was drawn. As the healthcare services offered via telemedicine are increasing at an exponential rate, continued evaluation will be needed to determine how different patient groups interact with these services and to consider the potential impact of widespread implementation.…”

“…A study of veterans found that patients who were non-White or of Hispanic origin tended to be more familiar with virtual care compared to White patients [ 29 ]. However, other studies have found that non-Hispanic Blacks tend to use less virtual healthcare compared to Whites, but not Hispanic patients [ 30 , 31 ]. Discrepancies between previous findings underscore familiar challenges associated with implementing new care innovations and the importance of diversity and inclusion during early design and evaluation phases.…”

Frequency of Eye Diseases in Residents of Nursing Homes – 1-Year Results of a Novel Telemedicine Service in Switzerland

“…The majority had a diagnosis of dementia (54.5 %) and 20.2 % had diabetes mellitus requiring treatment. The median care level (ranging from 0-12) was 7 (interquartile range [6][7][8][9], corresponding to a care need of 121-140 min/d. The mean best-corrected decimal visual acuity was 0.55 (SD 0.24).…”