Clinical Ophthalmology (Jul 2022)
Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic
Abstract
David J Ramsey,1,2,* Claudia C Lasalle,1,2,* Sidrah Anjum,1 Jeffrey L Marx,1,2 Shiyoung Roh1,2 1Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA, 01805, USA; 2Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA*These authors contributed equally to this workCorrespondence: David J Ramsey, Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, 1 Essex Center Drive, Peabody, MA, 01960, USA, Email [email protected]: 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%, χ2=36.172, P< 0.001). However, both groups accessed telehealth services at a similar rate during this period (21.1% versus 21.9%, χ2=0.417, P=0.518). Importantly, patients who received telehealth services returned for subsequent, in-person eye examinations at substantially higher rates, regardless of race (51.0% and 46.6%, respectively, χ2=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%, χ2=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.Keywords: telehealth, diabetes, diabetic retinopathy, quality improvement, medical care delivery
