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

Abstract

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.

The Association of Telehealth Availability and Quality of Care Measures for Patients With Diabetes at Federally Qualified Health Centers: Retrospective Cohort Study

“…This study indicates that high FQHC-level telehealth use was associated with more sustained engagement in care for patients with diabetes at FQHCs in Massachusetts, with mixed effects on quality of care measures. Telehealth availability likely helped to partially mitigate the overall decrease in visit rates during COVID-19 by improving care access, while telehealth visits may have also provided the opportunity to encourage patients to return for in-person retinal screenings [7]. In contrast, decreases in measured blood pressure control may have resulted from the lack of standardized blood pressure documentation in EHRs during telehealth visits rather than poor control, although this was untestable in our data.…”

Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography

“…Future studies should address these gaps because it is known from studies that examined patients who identified as members of racial or ethnic minority groups in the USA that they face a disproportionately high burden from DR[ 1 2 ] and at the same time are less likely to access eye care. [ 35 ] Another limitation is that we used two FFA systems, which differ in contrast, resolution, and other machine-based variables; however, our study lacks the power to evaluate these differences. The platform-independent nature of our image alignment method likely moderates some of the impact from these differences.…”

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting

“…Previous studies have revealed that certain demographic factors, such as sex and diabetes control, can influence the likelihood of male patients seeking in-person ophthalmology services, including during the COVID-19 pandemic [ 46 ]. Our study found that patients who received TRI were more likely to be male.…”

“…The inclusion of only those patients who had completed a primary care visit within the study period, which spans the COVID-19 pandemic, also fails to capture patients who may have been disconnected from the healthcare system. Notably, such patients face not only poorer DM control but also an increased risk of developing DR [ 44 , 46 ]. Our electronic medical record-based study also misses the outcomes of eye care visits that occurred outside of our health system and were not reported back to a PCP.…”

“…Our study conducted among a suburban, well-insured population of patients with DM found that TRI was most often used to screen patients who were at a greater risk of not following through with traditional referrals for eye examinations, such as those who were male, identified as non-White, or had poorer metabolic control [ 7 , 22 , 23 , 46 ]. TRI provides an opportunity to reduce the costs of screening patients without prior DR compared with referring all eligible patients with DM for in-person eye examinations.…”