Adherence to urgent eye visits during the COVID-19 pandemic: A population characteristics study

ABSTRACT

Purpose: The rapid spread of coronavirus (COVID-19) has changed the way eye care practitioners provide care. As an early response to the pandemic, the Department of Ophthalmology at the University of Illinois at Chicago created a tele-triage system to screen patients requesting an urgent visit. The aim of this study was to explore demographic and community factors associated with adherence of patients scheduled for recommended urgent eye visits. Methods: Surveys of all individuals requesting an acute same day in-person visit between April 6, 2020 and June 6, 2020 were reviewed, and medical chart review was completed for patients recommended an urgent visit. Demographic data and adherence to visit were examined. Using ArcGIS, address was geocoded and census tract level variables were appended from the U.S. Census American Community Survey between 2014 and 2018. COVID-19 related death data during the study period were also included from the Cook County Medical Examiner's Office. Descriptive statistics, t-tests and binary logistic regression were used to compare variables. A p-value of ≤ 0.05 was considered statistically significant. Data was analyzed using SAS Institute Inc. 2018 (SAS 9.4M6, Cary, NC, USA). Results: A total of 229 patients were recommended an urgent visit. Of 216 patients with matching criteria on chart review, mean age was 46.6 ± 18.6 years. The majority of patients were female (55.6%) and Black or African American (40.3%), and most common insurance was Medicaid (36.6%). 192 patients (88.9%) reported for their scheduled visit. When comparing personal characteristics by adherence to visit, there was no difference based on gender (p=0.94), race (p=0.56), insurance status (p=0.28), nor new versus established status (p=0.20). Community level data showed that individuals who did not adhere to their visit more commonly came from neighborhoods with a greater proportion of Blacks or African Americans (59.4% vs. 33.4%;p=0.03), greater unemployment rates (17.5% vs. 10.7%;p<0.01), and greater cumulative deaths from COVID-19 (56 vs. 31;p=0.01). Conclusions: The findings from this study suggest that, in our patient population, COVID19 itself disproportionately affects black communities in terms of mortality, but also affects adherence to appointments which, in return, increases gaps in health equity.