A performance analysis of diabetic retinopathy screening at a student-run free clinic before and during the COVID-19 pandemic period

ABSTRACT

Purpose: To evaluate the impact of the COVID-19 pandemic on diabetic retinopathy screening (DRS) to uninsured, predominantly Latino patients at the UC San Diego Student-Run Free Clinic Project (SRFCP). Methods: A retrospective analysis of the electronic medical records of all diabetic patients seen in the years 2019, 2020, and 2021 (N = 196, 183, and 178 respectively) at the SRFCP was performed. Ophthalmology specialty clinic metrics from before, during, and after the COVID-19 pandemic-related lockdowns were compared to assess the impact of the COVID-19 pandemic lockdowns on DRS rates. All statistical analyses were performed in Microsoft Excel. Results: In patients with available demographic data (N=164), 92.1% were Latino, 69.5% female, with a mean age of 58.7 years (SD=10.6). A chi-squared test for goodness of fit showed that the distribution of patients seen (p<0.001), referred (p=0.012), or scheduled (p<0.001) in 2020 and 2021 differed significantly when compared to 2019. In 2019, 99 (50.5%) of 196 patients requiring DRS were referred, of which 97 (49.5%) were scheduled, and 89 (45.4%) were seen by the ophthalmology clinic (Figure 1). In 2020, a similar percentage of patients were referred (76/183 patients, or 41.5%), but the number of patients scheduled and seen dropped to 37 (20.2%) and 21 (11.4%), respectively. In 2021, clinic performance recovered with 113 (63.5%) of 178 patients eligible for DRS referred, 100 (56.2%) scheduled, and 82 (46.1%) seen. No-shows and cancellations constituted 12 (12.4%) and 6 (6.2%) of the 97 encounters in 2019. Conversely, of the 37 encounters scheduled in 2020, the no-show (10.8%) and cancellation (40.5%) rates were notably higher. Conclusions: The COVID-19 pandemic significantly diminished the delivery of eye care to patients at the SRFCP. 2020 saw a meaningful decline from 2019 in all clinic performance metrics which was reversed in 2021. These results show the current need for annual DRS surpassed the ability of the ophthalmology specialty clinic to schedule and deliver care to these patients in all years evaluated, especially in 2020 due to COVID-19 restrictions. SRFCP patients may benefit from telemedicine-based DRS programs such as remote imaging during primary care visits to further improve screening capacity. (Figure Presented).