The Impact of Primary Care Provider Telemedicine Adoption on Pediatric Ophthalmology Referrals.

Introduction: This study aims to assess how the adoption of telemedicine by primary care providers influenced new patient referrals to pediatric ophthalmology.

Methods: Retrospective chart review of new pediatric ophthalmology referrals from primary care providers within the same 3 months (April, August, and December) each year between 2019 and 2021. Patient demographics, reason for referral, and recommended continued ophthalmical care (as a proxy for referral quality) were evaluated. Logistic regression models, chi-square tests, and Mann-Whitney tests were performed to assess the impact of telemedicine referrals.

Results: Of the 1,181 referrals reviewed, 551 were included in the final analysis. Telemedicine use increased over time (p < 0.005). Comparing telemedicine and in-person referrals, there was no difference in patient age, sex, race, language, or insurance type (all p > 0.05). A significant difference was observed between the reasons for referrals by referral type (p < 0.005). The most common reason for telemedicine referrals was ophthalmic manifestations of systemic diseases, while the most common reason for in-person referrals was failed vision screening. Patients with public insurance and those referred after 2020 had higher odds of recommended continued care (adjusted odds ratio [OR]: 1.67, p = 0.01 and 1.98, p = 0.002), though referrals based on telemedicine visits were less likely to require continued ophthalmic care (adjusted OR: 0.33, p = 0.001).

Conclusion: Pediatric ophthalmology referrals were influenced by the adoption of telemedicine by primary care providers. Referrals based on telemedicine visits were less likely to warrant continued ophthalmic care, suggesting that the impact of telemedicine on facilitating referrals and improving access to pediatric ophthalmology subspecialty care remains uncertain.