Telemedicine implementation, impact of pandemic on pediatric ophthalmic visits

A study has found that telemedicine and the pandemic have had an impact on the continuity of pediatric ophthalmic visits.

A study of patient characteristics impacting the continuity of pediatric ophthalmic care during the COVID-19 pandemic found that the beginning of the 2020 lockdown had 4 times the odds of incomplete visits compared with the previous year. Health disparities were found to impact visit completion and telemedicine utilization, according to Jenay Yuen and members of the multicenter research team led by Alejandra de Alba Campomanes, MD, MPH, at the University of California San Francisco.

Following the start of the pandemic, the role of telemedicine increased rapidly in clinical practices. Despite this, previous studies have shown the technology to be underutilized by older patients, Black and Latinx patients, and those of lower socioeconomic status, the investigators explained.

Because information is lacking about telemedicine disparities in the pediatric ophthalmology population, Yuen and colleagues conducted a retrospective, cross-sectional study of scheduled pediatric ophthalmology encounters before and during the initial COVID-19 pandemic. The study aimed to determine the effect of the pandemic shutdown on the odds of pediatric ophthalmology visit completion, along with factors associated with receiving visits via telemedicine.

More than 11,000 pediatric patients were included in this multicenter study. The participating institutions were the University of California San Francisco, Children’s Hospital Los Angeles, and the Oregon Health and Science University in Portland. All patients had appointments scheduled before the pandemic (March 2019 to June 2019) or after the onset of the pandemic (March 2020 to June 2020).

Impact of the COVID-19 pandemic on completed visits

The investigators reported that the completion rate of scheduled visits decreased from 72.4% in 2019 to 32.6% in 2020. Notably, only 8.8% of scheduled visits in March 2020 were completed, including both in-person and telemedicine modalities, which is a drastic decrease from 71.3% in March 2019. During the first 4 months of the pandemic, 51% of completed visits were conducted remotely via telemedicine. “The odds of not completing a visit in March to June 2020 were 4.77 times higher than that of 2019, after adjusting for sociodemographic and neighborhood variables,” Yuen said. 

Odds of an incomplete ophthalmic visit

Race and ethnicity, age, and preferred language were found to be relevant factors in this analysis.Specifically, Black patients had 1.35 times the odds of having an incomplete visit compared with non-Hispanic White patients in either year, after adjusting for other demographic and neighborhood characteristics. In both years, older children had increased odds of having an incomplete visit compared with patients younger than 1 year (odds ratio [OR], 1.44-1.85; all P < .001). Patients who were non-English speaking and needed an interpreter had lower rates of completed visits in 2020.

Factors predicting remote ophthalmic visits in 2020

The primary factors impacting telemedicine use were follow-up appointments, presence of extraocular disease (compared with intraocular pathology), and race. In 2020, patients scheduled for follow-up appointments had 4.77 times the odds of having a remote visit compared with new patients.

Patients with nonextraocular diagnoses had lower odds of engaging in a remote visit compared with patients with a primary diagnosis of an extraocular disease (OR, 0.12-0.51; P < .05 for all comparisons).

Univariate analysis showed that all racial-ethnic groups had lower odds of engaging in a remote visit compared with non-Hispanic White patients. However, multivariate analysis did not show a significant difference.

The investigators enumerated these important findings, ie, that the initial period of the COVID-19 pandemic in 2020 was independently associated with the odds of an incomplete visit 4 times higher than that of the previous year, and that Black patients, older children, and patients who were non-English speaking were more likely to have incomplete visits.

“It is clear that health disparities exist and impact the rates of completed pediatric ophthalmology visits,” the investigators concluded. “[Although] these effects also impact the likelihood of having a remote visit, additional variables such as visit type and ocular disease seem to play an even larger role. Therefore, it is important to consider these additional clinical variables when considering the effectiveness of telemedicine in mitigating health disparities and increasing access to care.”

Jenay Yuen

E: jenayyeu@usc.edu

Yuen is a medical student at the University of Southern California (USC) Roski Eye Institute, Keck School of Medicine of USC.