Disparities in Eye Care Utilization During the COVID-19 Pandemic

Elam, Angela R.; Sidhom, David; Ugoh, Peter; Andrews, Chris; Lott, Lindsey B. De; Woodward, Maria A.; Lee, Paul P.; Newman-Casey, Paula Anne

doi:10.1016/j.ajo.2021.07.024

Cited by 26 publications

(40 citation statements)

References 26 publications

(34 reference statements)

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“…The increase in telemedicine utilization we report is a generalized trend across a range of medical specialties [4] and it constitutes a hallmark of the innovation triggered by this pandemic. Albeit the positive feedback by physicians and patients we report, telehealth risks to increase inequalities in access to care [166, 167].…”

Section: Discussionmentioning

confidence: 99%

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

Carvalho

Fernandes

Lange

et al. 2022

Preprint

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Objectives: Summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020), and to assess changes in the quality of care as assessed via selected indicators. Methods: Scoping review. Indicators and their reported trends were collated following the cancer care pathway. Results: Database searches retrieved 6277 articles, 838 articles met the inclusion criteria, and 135 articles were included after full-text screening, from which 917 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n=30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n=64, 58%) and in the diagnoses (n=130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed an increasing trend (n=8, 89% and n=14, 56%, respectively). Nine indicators (64%) showed stability in cancer stages distribution. A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n=9), and 70% (n=43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79% (n=82) of indicators concerning surgeries, 72% (n=41) of indicators assessing trends in radiotherapy, and 93% (n=40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64% (n=195) of indicators revealed changes in treatment. Ten indicators (83%) signalled a decreasing number of hospital admissions. Conclusion: Health systems struggled to ensure continuity of cancer care. As this pandemic keeps evolving, the trends reported over the first 6 months of 2020 provide an argument to monitor these changes closely. This information needs to be transparent, standardised, and timely, allowing to monitor quality and outcomes of care during crises and inform policy responses.

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Section: Discussionmentioning

confidence: 99%

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

Carvalho

Fernandes

Lange

et al. 2022

Preprint

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“…By contrast, prior to the emergence of COVID-19, the rate-of-return was similar for White patients, compared with those identifying as other races and/or ethnicities at our medical center. Not surprisingly, COVID-19 acted as a barrier to care, exacerbating historic inequities, 17,18,21,[25][26][27][28] especially given that individuals from racial and/or ethnic minority groups were disproportionately affected by COVID-19 infections. 19 In view of the rapid transition required to make services possible for our patients during the COVID-19 pandemic, the finding that telehealth increased the rate at which diabetic patients returned for in-person eye examinations is an encouraging finding, especially with regard to those who had DR and worse vision.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] The pandemic had a disproportionately greater impact on patients from racial and/or ethnic minority groups, significantly reducing their ability to access eye care. 17,18 Well-equipped offices, especially those associated with academic medical centers, rapidly transitioned to providing eye care through telehealth visits as an important method to care for vulnerable patients after the outbreak of COVID-19. 17,19 These visits protected both patients and providers from the risks associated with exposure to COVID-19, 20 and allowed providers to deliver health education and outreach as a temporizing measure while in-person care was limited by stay-at-home advisories and strict social distancing standards.…”

Section: Introductionmentioning

confidence: 99%

Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic

Ramsey¹,

Lasalle²,

Anjum³

et al. 2022

OPTH

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The COVID-19 pandemic had a disproportionate impact on patients from racial and/or ethnic minority groups, causing many to delay healthcare. This study evaluates the role telehealth visits played in helping patients with diabetes mellitus (DM) return for subsequent, in-person eye examinations after the outbreak of COVID-19. Methods: This retrospective, cross-sectional study analyzed 8147 patients with DM who had completed an outpatient ophthalmology and/or optometry visit in 2019 and who were due for return evaluation after the outbreak of COVID-19 in 2020. Factors associated with return for subsequent, in-person eye examination were assessed. Results: The mean age of patients was 68.8 (±13.0) years, and 42% were women. 7.4% of patients identified as Asian; 2.9% as Black; 3.4% as Hispanic or Latin American; 0.92%, as more than one race; 1.78%, as other races; and 80.7% as White. Patients from racial and/or ethnic minority groups completed fewer in-person eye examinations after the outbreak of COVID-19 compared with White patients (35.6% versus 44.5%, χ 2 =36.172, P<0.001). However, both groups accessed telehealth services at a similar rate during this period (21.1% versus 21.9%, χ 2 =0.417, P=0.518). Importantly, patients who received telehealth services returned for subsequent, inperson eye examinations at substantially higher rates, regardless of race (51.0% and 46.6%, respectively, χ 2 =1.840, P=0.175). This offset the otherwise lower rate of return experienced by patients from racial and/or ethnic minority groups compared with White patients among the group of patients who did not receive any telehealth services (32.7% versus 42.7%, χ 2 =36.582, P<0.001). The impact of telehealth on the likelihood of in-person return remained significant after taking into account age, gender, race, language, residence, severity of diabetic retinopathy (DR), and vision in a multivariate model. Conclusion:Telehealth initiatives benefited patients from racial and/or ethnic minority groups by reducing disparities in access to eye care experienced during the COVID-19 pandemic.

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“…At the beginning of the COVID-19 pandemic, utilization of ophthalmologic telemedicine services reflected several disparities. 1 Specifically, older adults, 2 – 4 minorities, 2 , 4 non-English-speaking individuals, 2 or those with lower income 3 were less likely to have a video visit. Blind and visually impaired participants were significantly less likely to have heard of telehealth or virtual care.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of Telerehabilitation for Magnification Devices for the Visually Impaired Using Various Approaches to Facilitate Accessibility

Bittner

Yoshinaga

Shepherd

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose We examined different methods to reduce the burden of accessing technology for videoconferencing during telerehabilitation for magnification devices for the visually impaired. Methods During telerehabilitation studies over the past 5 years, vision rehabilitation providers assessed and gave training to visually impaired participants with newly dispensed magnification devices at home who connected to Zoom videoconferencing via loaner tablets or smartphones with assistance from (phase 1; n = 10) investigators by phone, (phase 2; n = 11) local Lions Club volunteers in participants’ homes, or (phase 3; n = 24) remote access control software in a randomized controlled trial with 13 usual care controls who received in-office training. All participants completed the same post-telerehabilitation phone survey. Results A significantly greater proportion of phase 3 subjects indicated they strongly or mostly agreed that the technology did not interfere with the session (96%) compared to phase 1 (60%; 95% confidence interval [CI], 1.2–12.5; P = 0.03) or phase 2 (55%; 95% CI, 1.8–188; P = 0.01). The majority indicated telerehabilitation was as accurate as in person (68%), they were comfortable with telerehabilitation (91%) and interested in a future session (83%), and their magnifier use improved (79%), with no significant differences in these responses between phases (all P > 0.10), including comparisons of participants randomized to telerehabilitation or in-office training in phase 3 who reported similar overall satisfaction levels ( P = 0.84). Conclusions Participants across all phases reported high levels of acceptance for telerehabilitation, with least interference from technology using remote access control in phase 3. Translational Relevance With accommodations for accessibility to videoconferencing technology, telerehabilitation for magnification devices can be a feasible, acceptable, and valuable option in countries with resources to support the technology.

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Disparities in Eye Care Utilization During the COVID-19 Pandemic

Cited by 26 publications

References 26 publications

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a Scoping Review

Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic

Acceptability of Telerehabilitation for Magnification Devices for the Visually Impaired Using Various Approaches to Facilitate Accessibility

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