Abstract
Purpose :
To examine the association of urban versus rural residence with the use of telemedicine among California (CA) Medicare beneficiaries with chronic eye disease.
Methods :
The study population included 2019 CA Medicare Beneficiaries with International Classification, 10th Revision, Clinical Modification codes for glaucoma, cataract, age-related macular degeneration and diabetic retinopathy. Beneficiaries were included if they resided in CA during 2019, were ≥65 years old, enrolled in Medicare Parts A and B regardless of having Part B claims in 2019. Telemedicine appointments were identified based on current procedural terminology for telehealth visits, virtual check-ins, online medical evaluation, and remote patient monitoring. Urban and rural residency was determined by ZIP codes using the Health Resources and Services Administration (HRSA) List of Rural Counties Designated Eligible Census Tracts in Metropolitan Counties and the SSA to Federal Information Processing Series (FIPS) Core-Based Statistical Area (CBSA) and Metropolitan and Micropolitan County Crosswalk files. The association between residence type and telemedicine use was assessed using logistic regression, adjusting for age, sex, race/ethnicity, and Charlson Comorbidity Index.
Results :
The study population includes 997,977 CA Medicare beneficiaries. A total of 607,626 (61%) beneficiaries had at least one telemedicine claim, and 278,146 (28%) beneficiaries resided in areas with rural ZIP codes. The majority of 2019 CA beneficiaries that utilized telehealth were female (60%) as well as within the age group of 70-74 (25.8%). Moreover, self-reported race and ethnicity were: 64.2% White, 3.8% Black, 13.9% Asian, 13.7% Hispanic and 4.4% Other. Rural versus non-rural residence was associated with decreased adjusted odds of telehealth use (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.95 – 0.96).
Conclusions :
In 2019, Medicare beneficiaries who resided in rural areas of California had decreased likelihood of using telemedicine for chronic eye disease management compared to beneficiaries in non-rural areas. Further studies are needed to characterize and understand whether these findings translate to disparities in clinical outcomes and healthcare utilization for eye conditions based on geographic location of residence.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.