Abstract
Purpose :
Delay in outpatient chronic care management can lead to a rise in acute complications. COVID-19 related clinic and ambulatory shutdowns came into effect in South Texas by the end of 3/2020. Recent studies have shown delays in care and more severe disease presentations during the COVID-19 shutdown. We evaluate trends in ophthalmic pathologies in relation to patient follow-up behaviors after ED and inpatient encounters in South Texas.
Methods :
A retrospective study used electronic medical records to collect consultation logistics, patient clinical data, and clinical follow up for ophthalmic inpatient and emergent encounters from 7/2019 - 7/2020. Proliferative disease-associated vitreous hemorrhage (VH) and neovascular glaucoma (NVG) were used as markers for acute on chronic complications. Patient follow-up rate and time were compared to recommended follow-up during the two eras to analyze trends in patient behavior.
Results :
501 records were evaluated. Pre- and post-shutdown weekday (14 hour) volume of encounters were 5.7±3.2 and 3.7±2, respectively. Weekend (24 hour) encounters changed from 12.7±4.6 to 9.9±5.5. Pre-shutdown average weekday time of encounter was 21:36±4.6 hrs compared to 20:59±4.0 hrs post-shutdown, and for weekend time of encounter was 19:49±6.2 hrs compared to 19:23±5.6 hrs. Pre-shutdown recommended follow-up was 6.9±8.7 days compared to 9.9±10.5 days post-shutdown, with patients delaying the originally recommended appointment by 11.3±50.9 days pre-shutdown and 7.1±25.3 days post-shutdown. Missed appointment rate was 35% pre-shutdown and 47% post-shutdown. Of the 216 pre-shutdown encounters, 9% needed urgent surgery and 5% needed a bedside procedure. Post-shutdown, 8% needed surgery and 6% needed a bedside procedure. Pre- and post-shutdown incidence respectively was 4% and 4% for NVG, and 5% and 7% for VH.
Conclusions :
During the COVID-19 shutdown, the volume of ophthalmic ED evaluations decreased, but not significantly. Patient encounter time and procedural intervention rate were also not significantly altered, suggesting that the urgency profile of pathologies did not change significantly. More patients missed clinic follow-up but appointment delays were comparable to the pre-shutdown era. There was a slightly higher incidence of acute on chronic proliferative pathologies.
This is a 2021 ARVO Annual Meeting abstract.