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

David J Ramsey; Claudia C Lasalle; Sidrah Anjum; Jeffrey L Marx; Shiyoung Roh

doi:10.2147/OPTH.S368972

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

Clin Ophthalmol. 2022 Jul 4:16:2157-2166. doi: 10.2147/OPTH.S368972. eCollection 2022.

Authors

David J Ramsey^#^{1

2}, Claudia C Lasalle^#^{1

2}, Sidrah Anjum¹, Jeffrey L Marx^{1

2}, Shiyoung Roh^{1

2}

Affiliations

¹ Department of Surgery, Division of Ophthalmology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA, 01805, USA.
² Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, 02111, USA.

^# Contributed equally.

Abstract

Purpose: 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, in-person 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.

Keywords: diabetes; diabetic retinopathy; medical care delivery; quality improvement; telehealth.

Grants and funding

D.J.R.: Supported by the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health. C.C.L.: Supported by a grant from Office of Medical Education, Lahey Hospital & Medical Center, Beth Israel Lahey Health.