Teleretinal Imaging Enhances Equity in Diabetic Eye Screening at Urban Community Health Clinics.

BACKGROUND

We evaluated the impact of a teleretinal screening program on increasing diabetic eye screening within urban community health clinics and factors associated with screening receipt.

MATERIALS AND

METHODS

A clinical teleophthalmology program providing teleretinal imaging for diabetic eye screening was introduced at two clinics (Clinics A and B) in an urban federally qualified health center in Madison, Wisconsin. We conducted a retrospective, cross-sectional study during the baseline (2020-2022) and teleophthalmology (2022-2024) periods and used logistic regression to identify factors associated with screening receipt.

RESULTS

During the baseline period, patients (n = 1,094) had a mean age of 54 years, with 24.0% self-identifying as Black/African American and 44.8% as Hispanic/Latino, and 30.0% were uninsured. Screening increased from 14.4% to 40.3% (p < 0.001) in the teleophthalmology period, with the largest increases observed among Hispanic/Latinos (+32.1%) and the uninsured (+33.6%). In the multivariable analysis, men and uninsured patients became equally likely to receive screening in the teleophthalmology period as women and Medicare patients, respectively. However, those with Medicaid or commercial insurance remained less likely to obtain screening (OR: 0.63-0.69, 95% CI: 0.44-0.99) than those with Medicare. Those obtaining care at Clinic B were less likely to obtain screening than those at Clinic A in the baseline period but were more likely to obtain screening in the teleophthalmology period (OR: 1.75, 95% CI: 1.37-2.23).

CONCLUSIONS

Teleophthalmology increased diabetic eye screening equity based on sex and insurance status. Clinic-level strategies to enhance patient outreach, clinical staff engagement, and clinic resource allocation may allow for further advances in telemedicine screening equity.