ABSTRACT
Purpose : The aim of this study is to determine whether telehealth (TH) appointments improve the rate of return for in-person diabetic eye exams. Methods : A retrospective chart review was conducted to determine the rate of return for in-person diabetic eye examinations for patients with diabetes who had been seen in the Department of Ophthalmology at the Lahey Hospital & Medical Center in 2019. Since TH appointments were not initiated at the Lahey Hospital & Medical Center until March 16, 2020 in response to the COVID-19 pandemic, this study looked at only patients who were seen after this date. The main outcome was the number of in-person diabetic eye exams completed by patients who had a prior TH encounter compared with those that did not have a TH encounter. Patient demographic (age, gender, ethnicity, and race) and clinical characteristics (A1c, type of diabetes, and severity of retinopathy) were abstracted from the medical record. Results : Of the 7,796 patients with a diagnosis of diabetes who were seen in 2019, 1,723 (22.1%) completed TH appointments in 2020. The rate of return for in-person diabetic eye examinations was significantly greater for the cohort of patients who completed a TH appointment compared with those who did not (44.6% compared with 36.5%, OR: 1.71 95% CI: 1.54 - 1.90, p<0.0001). Patients with diabetic retinopathy were more likely to complete a TH visit. Of the 1,202 patients with diabetic retinopathy, 365 patients (30.4%) competed a TH appointment. In contrast, only 1,294 of the 5,999 patients (21.6%) without a history of retinopathy competed a TH appointment (χ =43.693, p <0.0001). For both groups the likelihood that a patient would subsequently complete an in-person diabetic eye exam increased after the completion of a TH encounter: 74% of patients with diabetic retinopathy completed an in-person visit after a TH appointment, compared with 49.6% of patients who returned for in-person care without a prior TH appointment (OR: 2.89;95% CI: 2.20 - 3.79, p<0.0001). Similarly, 44.6% of patients without retinopathy who completed a TH visit returned for in-person care, compared with only 36.5% who did not complete a TH visit (OR: 1.40;95% CI: 1.24 - 1.59, p<0.0001). Conclusions : TH appointments are an effective method to improve the likelihood that patients with diabetes and diabetic retinopathy will return for recommended in-person care.