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Dr David Ramsey Describes the Impact of Telehealth on Completed Eye Examinations for Diabetic Retinopathy


David Ramsey, MD, PhD, MPH, explains findings from a study on telehealth use among patients with diabetes in Massachusetts.

Patients who received telehealth services throughout the pandemic were more likely to return to an in-person visit, said David Ramsey, MD, PhD, MPH, an ophthalmologist and director of ophthalmic research at Lahey Hospital and Medical Center of Beth Israel Lahey Health. Ramsey presented research during an American Academy of Ophthalmology 2021 conference session called "Telehealth Encourages More Minority Patients With Diabetes to Return for In-Person Care During the COVID-19 Pandemic." Research coauthors included Karen Latulippe; Jeffrey L. Marx, MD; Shiyoung Roh, MD; Claudia C. Lasalle; Sidrah Anjum; and Ed Momplaisir.


How did you carry out your study on telehealth visits among patients with diabetes during the pandemic?

The study that we have presented was conducted retrospectively of all patients with diabetes or diabetic retinopathy who were due for return in-person care during the first year of the COVID-19 pandemic. These patients were due for care after the outbreak of COVID-19 and although that particular pandemic affected different parts of the country at different times, in Boston, we were very early on affected and we very quickly pivoted to deliver telehealth services. This allowed us to look at the outcomes of patients that received a telehealth visit, which is not something that is replacing an in-person eye exam but was more of a temporizing measure to determine the extent to which these patients had been able to return for in-person care that is necessary for monitoring, managing, and in some cases treating their diabetes and diabetic retinopathy.

What were the main findings of your study?

The findings that we presented that were most exciting were that telehealth services delivered to patients with diabetes and diabetic retinopathy benefited the vast majority of patients who received them, insofar as they returned, subsequent to the telehealth service, for an in-person visit. Patients that received telehealth were 50%, or, in times, up to 100% more likely to return for in-person care in the first year of the pandemic, compared with those that had not received telehealth services.

But when we looked at the data retrospectively, and we've looked along lines of race and ethnicity, the thing that was most surprising is that it appears as if there is an even greater benefit for patients who are neither White nor Hispanic. Patients in groups, such as those who are Black or African American, Asian or Asian American, Hispanic or Latino, had an even more beneficial effect of telehealth in that it made them more likely to return for in-person visits if they had received the service compared with those members of the very same groups that had not. Looking at the data, what we presented was that this improvement and relatively greater effect was in part due to the fact that there was a greater gap in the return rate between White non-Hispanic patients and those of other groups. Before the pandemic, in the year 2019, there was no statistical difference in the rate of return. Patients with diabetes and diabetic retinopathy returned at relatively equal levels for in-person subsequent eye care.

But after the outbreak of COVID-19, we saw that patients from minority groups, specifically those that were Black or Hispanic or Asian, had a lower overall return rate compared to non-Hispanic White patients. So in other words, this gap widened or formed between these 2 groups and telehealth went part of the way toward closing that gap. It did benefit these patients to a greater extent than, let's say, their non-Hispanic White counterparts. But it didn't close the gap completely. Patients from these minority groups still returned at a lower rate compared with non-Hispanic White patients. There's still a great deal of work to do. Nonetheless, the intervention of telehealth was beneficial and to a greater extent with these groups.

The other point I would like to make from our retrospective review is we found that there was absolutely no difference in the rate of patients, the percent of patients that received telehealth services, whether they were White or Black, Hispanic or Asian, there was equal receipt of telehealth and the benefits led to a relatively greater return rate amongst groups that had a larger tendency not to return, let's say.

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