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  • Health Care Disparities and Telemedicine During COVID

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, November 2021

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    Aziz et al. assessed whether health care disparities were involved in the delivery of ophthalmic telemedicine during the first year of the COVID pandemic. They found that historically marginalized populations were less likely to receive telemedical care during this time.

    For this retrospective cross-sectional study, the researchers analyzed clinical visits at Massachusetts Eye and Ear (MEE) from Jan. 1 to Dec. 31, 2020. Primary outcomes included the demographic characteristics of patients who received telemedical care during the year. Secondary outcomes included visit type (telemedicine or in-clinic), diagnosis, and patient type (new or established). Multivariate logistic regression analysis was used to assess the data. And because access to video technology can be a barrier to using telemedicine, the researchers further compared telephone-based to video-based telemedical visits.

    All told, 155,131 ophthalmic clinical visits took place at MEE during 2020. Of these, 2,262 were telemedicine encounters that involved 1,911 patients. The median age of patients seen via telemedicine was 61 years (range, 43-72), and the majority were White (76.14%) and female (61.7%). In addi­tion, those who received telemedical care were more likely to speak English as their primary language and to have a higher educational level (college or postgraduate education). Those who were male, identified as Black, had an educational level of high school or less, and did not speak English as a primary language were less likely to receive telemedical care during the year.

    When the researchers compared telephone-based to video-based care, they found a similar pattern, with older, less educated, and poorer patients less likely to use video-based care.

    The study has several limitations, the researchers acknowledge, including its retrospective design. Nonetheless, they said, the “potential exacerbation of health inequalities through the use of ophthalmic telemedicine” points to an ongoing need to prioritize equitable health care delivery throughout all of ophthalmology, including telemedical visits. (Also see related commentary by Brian L. VanderBeek, MD, MPH, MSCE, in the same issue.)

    The original article can be found here.