Health disparities: How the pandemic had an impact on paediatric ophthalmic visits

This article was reviewed by Jenay Yuen.

A study of patient characteristics impacting on the continuity of paediatric ophthalmic care during the COVID-19 pandemic found that the beginning of the 2020 lockdown had four times the odds of incomplete visits compared with the previous year.

According to Jenay Yuen and members of the multicentre research team led by Dr Alejandra de Alba Campomanes at the University of California San Francisco, California, United States, both visit follow-throughs and telemedicine utilisation were found to be impacted by health disparities.

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

Because information on telemedicine disparities in the paediatric ophthalmology population is lacking, Ms Yuen and colleagues conducted a retrospective, cross-sectional study of scheduled paediatric 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 paediatric ophthalmology visit completion, along with factors associated with receiving visits via telemedicine.

More than 11,000 paediatric patients were included in this multicentre 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, Oregon, US. 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 pandemic on 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 was 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 neighbourhood variables,” Ms Yuen said.

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 neighbourhood 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 < 0.001). Patients who were non-English-speaking and needed an interpreter had lower rates of completed 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 non-extraocular diagnoses had lower odds of engaging in a remote visit compared with patients who had a primary diagnosis of an extraocular disease (OR 0.12-0.51; P < 0.05 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: namely, that the initial period of the COVID-19 pandemic in 2020 was independently associated with the odds of an incomplete visit four 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 paediatric 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

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