Adherence to Urgent Eye Visits during the COVID-19 Pandemic: A Population Characteristics Study.

Purpose: To explore individual and community factors associated with adherence to physician recommended urgent eye visits via a tele-triage system during the COVID-19 pandemic.
Method: We retrospectively reviewed acute visit requests and medical exam data between April 6, 2020 and June 6, 2020. Patient demographics and adherence to visit were examined. Census tract level community characteristics from the U.S. Census Bureau and zip code level COVID-19 related death data from the Cook County Medical Examiner's Office were appended to each geocoded patient address. Descriptive statistics, t-tests, and logistic regression analyses were performed to explore the effects of individual and community variables on adherence to visit.
Results: Of 229 patients recommended an urgent visit, 216 had matching criteria on chart review, and 192 (88.9%) adhered to their visit. No difference in adherence was found based on individual characteristics including: age ( p = .24), gender ( p = .94), race ( p = .56), insurance ( p = .28), nor new versus established patient status ( p = .20). However, individuals who did not adhere were more likely to reside in neighborhoods with a greater proportion of Blacks (59.4% vs. 33.4%; p = .03), greater unemployment rates (17.5% vs. 10.7%; p < .01), and greater cumulative deaths from COVID-19 (56 vs. 31; p = .01). Unemployment rate continued to be statistically significant after controlling for race and cumulative deaths from COVID-19 ( p = .04).
Conclusion: We found that as community unemployment rate increases, adherence to urgent eye visits decreases, after controlling for relevant neighborhood characteristics. Unemployment rates were highest in predominantly Black neighborhoods early in the pandemic, which may have contributed to existing racial disparities in eye care.