Primary care telehealth visits are associated with earlier eye care in diabetic patients with high socioeconomic vulnerability

Abstract

Purpose

To identify factors associated with an ophthalmology visit in patients with Type 2 Diabetes Mellitus (T2DM), particularly among patients with high socioeconomic vulnerability (SeV).

Design

Comparative utilization analysis.

Methods

A retrospective review of the Duke Epic Database was performed on outpatient visits with a T2DM diagnosis between January 1, 2019 and January 1, 2024. Patients were included if they were over the age of 18 and had a subsequent outpatient visit 1 year after their first documented visit. Age, race, sex, hemoglobin a1c values, zip codes of residence and outpatient primary care clinic, and usage of primary care telehealth visits and nutrition services were also collected. SeV scores were calculated from the Social Vulnerability Index, established by the CDC. Logistic regression models were used to calculate odds ratios for health care services on the first ophthalmology visit and diabetic retinopathy diagnoses at first visit.

Results

Of the 42,151 patients with T2DM, 12,491 (29.6 %) visited an ophthalmology clinic. 35.6 % (3,677/10,338) of the lowest SeV quartile (least vulnerable) and 26.3 % (2,821/10,716) of the highest SeV quartile (most vulnerable) visited an ophthalmology clinic. In both SeV quartiles, primary care telehealth visits and nutrition services were associated with an increased odds of ophthalmology visit (p < 0.001). Odds of proliferative diabetic retinopathy (PDR) at first ophthalmology visit were 75 % higher in the highest SeV quartile compared to the lowest SeV quartile (95 % CI: 1.29–2.38, p < 0.001). When SeV quartiles were evaluated separately, telehealth was associated with significantly reduced odds of PDR at initial ophthalmology visit in only the highest SeV quartile (p = 0.03).

Conclusion

We found that primary care telehealth visits are associated with both an increased odds of visiting an ophthalmology clinic and a reduced odds of PDR at this first visit in patients who reside in areas with the highest levels of socioeconomic vulnerability. Additional studies on telehealth services, especially in patients with high SeV, are warranted and could help to improve understanding of the role of technology in screening for diabetic retinopathy.