Abstract
Purpose :
Telemedicine utilization has risen dramatically during the COVID-19 pandemic, particularly during the state-wide shut down, but multiple factors contribute to its potential inaccessibility to different populations. To explore these factors, we conducted a prospective mixed-methods study to assess the relationship between telemedicine utilization and socio-demographic factors among patients seeking eye care. We also assessed patient satisfaction with eye care using a health disparities lens.
Methods :
We conducted phone interviews with a stratified random sample of 1,720 patients who had a visit scheduled at the University of Michigan Kellogg Eye Center in Ann Arbor, Michigan from 4/30/20-5/25/20 to ascertain patient perception of care received during the COVID-19 pandemic. The participant data was stratified by visit type and then analyzed by demographic variables. A Chi-square test was used to assess for association between categorical variables. Associations between visit type were determined using a multinomial logistic regression model. Open ended questions were stratified by race and analyzed using grounded theory to identify whether themes varied through a disparities lens.
Results :
Non-white patients had lower odds of having an in-person visit (p<0.02). Older patients had lower odds of having a video visit (p=0.007) and higher odds of having an in-person visit (p=0.023) compared to younger patients. The mean neighborhood median household income varied significantly (p<0.0001) by race with Blacks having the lowest estimated mean. Access to broadband signal with faster download speeds compared to slower was associated with lower odds of an in-person visit (p=0.022). No differences between races were identified in patient satisfaction or perception of care.
Conclusions :
Disparities existed in how patients accessed eye care during the COVID-19 pandemic with non-white patients less likely to access care. Coupled with other barriers such as lower income, which, on a population level, may limit access to broadband internet, reimbursing telemedicine solely through broadband internet connection may further exacerbate disparities in access to eye care. Insurers should consider continued reimbursement of telemedicine delivered via phone to prevent further marginalization of underserved communities.
This is a 2021 ARVO Annual Meeting abstract.