ABSTRACT
Purpose : Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada. Methods : Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results : In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. Conclusions : The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impact of the pandemic on the ophthalmic surgical backlog in Ontario.
ABSTRACT
Purpose : To describe the use and trends of virtual care and exam associated factors in Ontario, Canada during the 2020 COVID-19 pandemic. Methods : Ontario physician billing data from 2017-2020 was analyzed. Virtual care provided by ophthalmologists were identified from fee code and specialty codes. Percentage and adjusted odds ratio (aOR) from logistic regression models were used to assess patients' and ophthalmologists' factors associated with virtual vs in-person visits. Results : Virtual assessments/consults comprised 0.07%-0.10% of ophthalmology assessments/consults in 2017-2019 and 8.31% in 2020. The weekly uptake of virtual visits increased immediately in the week of the Ontario government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%, week March 16, 2020), peaked 2 weeks later (55.8%, week March 30, 2020) and reduced immediately after the directive was lifted (24.2%, week May 25, 2020). During the 2020 pandemic period, use of virtual care was higher in female (11.6%) vs male (10.3%) patients and in patients <20 (16.4%) and 20-39 years (12.3%) vs those aged 40-64 (10.8%) and 65+ (10.6%) years. Patients residing in the poorest/poorer neighbourhood area (10.9%) used virtual care similarly to their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or non-urgent diagnosis (16.2%) had the highest use. Those with a retinal disease diagnosis had the lowest use (4.2%). Female ophthalmologists provided virtual care more often than male ophthalmologists (15.4% vs 9.9%). Ophthalmologists aged 60-69 (13.1%) provided more virtual care than any other age groups (from 7.7% for 70+ years to 11.3% for <40 years). Regression analyses indicated a significantly higher chance of virtual care use in female (aOR=1.65) vs male ophthalmologists, in female (aOR=1.13) vs male patients, in patients <20 years (aOR=1.57) and 20-39 years (aOR=1.17) vs 65+, in patients residing in Central (aOR=1.37), East (aOR=1.52) and North (OR=1.13) regions vs those in the Toronto region. Compared with ophthalmologists aged 60-69 years, those in other age groups were less likely to use virtual care (aOR ranged 0.57-0.76). Conclusions : Virtual care in ophthalmology significantly increased during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.