Evolution of Disparities in Outpatient Ophthalmic Care at a Tertiary Care Center in California at the Beginning of and One Year into the COVID-19 Public Health Emergency

ABSTRACT

Purpose

To compare disparities in outpatient ophthalmic care during early and later periods of the COVID-19 public health emergency.

Methods

This cross-sectional study compared non-peri-operative outpatient ophthalmology visits by unique patients at an adult ophthalmology practice affiliated with a tertiary-care academic medical center in the Western US during three time periods: pre-COVID (3/15/19-4/15/19), early-COVID (3/15/20-4/15/20), and late-COVID (3/15/21-4/15/21). Differences in participant demographics, barriers to care, visit modality (telehealth, in person), and subspeciality of care were studied using unadjusted and adjusted models.

Results

There were 3095, 1172 and 3338 unique patient-visits during pre-COVID, early-COVID and late-COVID (overall age 59.5 ± 20.5 years, 57% female, 41.8% White, 25.9% Asian, 16.1% Hispanic). There were disparities in patient age (55.4 ± 21.8 vs. 60.2 ± 19.9 years), race (21.9% vs. 26.9% Asian), ethnicity (18.3% Hispanic vs. 15.2% Hispanic), and insurance (35.9% vs. 45.1% Medicare) as well as changes in modality (14.2% vs. 0% telehealth) and subspecialty (61.6% vs. 70.1% internal exam specialty) in early-COVID vs. pre-COVID (p < .05 for all). In late-COVID, only insurance (42.7% vs. 45.1% Medicare) and modality of care (1.8% vs. 0% telehealth) persisted as differences compared to pre-COVID.

Conclusions

There were disparities in patients receiving outpatient ophthalmology care during early-COVID that returned close to pre-COVID baseline one year later. These results suggest that there has not been a lasting positive or negative disruptive effect of the COVID-19 pandemic on disparities in outpatient ophthalmic care.

KEYWORDS:

• Ophthalmology
• COVID-19
• disparities
• tele-health
• telemedicine
• ambulatory care

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, HEM, upon reasonable request.

Financial support

National Institutes of Health (Bethesda, MD) P30 026877, Research to Prevent Blindness (New York, NY) Unrestricted grant. The sponsor or funding organization had no role in the design or conduct of this research.

This submission has not been published anywhere previously and that it is not simultaneously being considered for any other publication. This paper was previously reviewed and rejected by JAMA ophthalmology. Critiques includes single center nature, reliance on EHR derived data and limitation to non-surgical visits. We agree these are limitations of the study, but still believe it makes an important contribution to the literature, particularly since prior papers (which are also single center and rely on EHR data) did not compare time points within the COVID-19 PHE.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2023.2180807

Additional information

Funding

This work was supported by the National Eye Institute under Grant P30 026877; and Research to Prevent Blindness under an unrestricted grant;Harper-Inglis Memorial for Eye Research, The Peierls Foundation, That Man May See.