Pediatric Ophthalmology Provider and Staff Attitudes and Patient Satisfaction in Telehealth Implementation During COVID-19.

Purpose:Describe a comprehensive overview of a telehealth implementation process that highlights attitudes and satisfaction scores toward telehealth from patients, providers, and staff in an academic pediatric ophthalmology practice during the early months of the coronavirus disease 2019 (COVID-19) pandemic.Methods:The electronic medical record data for telehealth and in-person visits, as well as a patient experience survey in pediatric ophthalmology were retrospectively reviewed for March 1 to July 31, 2020 and March 1 to July 31, 2019. Patient experience survey results were retrospectively reviewed. All current providers and staff were invited to participate in an anonymous and voluntary survey focused on attitudes at the time of telehealth implementation.Results:During March 1 to July 31, 2020, there was significant increase in telehealth visits (n = 1,006) compared with the same period in 2019 (n = 22). Evaluation and management (E & M) codes (n = 527) were the most commonly used billing codes, and strabismus, nystagmus, and irregular eye movement (n = 496) were the most common telehealth primary diagnoses. The telehealth attitudes survey showed more positive responses from providers than staff. The patient experience survey showed more favorable scores for telehealth visits compared with clinic visits. However, only about 50% of the respondents were satisfied with the technology in terms of ease and quality of connection during their telehealth visits.Conclusions:Telehealth was a satisfactory alternative to clinic visits in our academic pediatric ophthalmology practice during the early phase of the COVID-19 pandemic. Providers and staff had largely positive attitudes toward telehealth; however, future efforts should include strategies to increase staff buy in. Patients had high satisfaction scores with telehealth visits despite connection challenges.

Access to Eye Care Before and After Vision Loss: A Qualitative Study Investigating Eye Care Among Persons Who Have Become Blind.

Navigating access to eye care requires that patients recognize the need for screening and care, employ limited financial and social resources, manage complex health insurance policies, and access specialty clinical care. We investigated the experience of patients through the progression of vision loss to blindness, utilizing qualitative methods. We conducted structured telephone interviews with 28 persons with blindness throughout Oregon. Utilizing closed and open-ended questions, we explored patient experience on the events preceding avoidable blindness. Coding for emergent themes was conducted independently by two researchers using a constant comparative method. Participants described important barriers to accessing eye care: at the systems level, lack of access to providers and treatment; at the community level, available social support and services; and at the individual level, readiness to act and trust in providers. These findings suggest that important barriers to accessing preventive eye care, early diagnosis and treatment, vocational rehabilitation, and social services often occur at multiple levels. Access to eye care should be prioritized in efforts to reduce preventable visual impairment.

Using registry data to characterize the incidence and causes of blindness in Oregon.

In the United States, there is no reliable data to describe the prevalence of eye diseases leading to visual impairment and little active surveillance to address this knowledge gap. Data that is readily available from many state blind registries may provide helpful information on trends and causes of blindness. We analyzed new registrations with the Oregon Commission for the Blind (OCB) and Oregon State Department of Administrative Services (DAS) from 1961 to 2016 for causes of and trends in blindness. Persons with blindness self-refer into the OCB registry and the Oregon State Department of Administrative Services (DAS) includes those receiving social security disability financial support and other state services. Data for 9,273 blind persons registered were analyzed. The most frequent causes of blindness were age related macular degeneration (AMD) 3,308 (38%), followed by diabetic retinopathy (DR) 729 (8%), congenital conditions 697 (8%), optic nerve atrophy 611 (7%), glaucoma 549 (6%), retinitis pigmentosa 546 (6%), retinopathy of prematurity192 (2%), cataract 180 (2%), and trauma 174 (2%). The mean age of onset of blindness was younger for Blacks (31 years) and Hispanics (33 years) than for Whites (44 years). Analysis of state-based registries can provide useful and locally relevant vision and eye health data where little information is otherwise available.

Barriers to eye care among participants of a mobile eye clinic.

PURPOSE: Barriers to health care present complex challenges to improving eye health in the U.S., yet few studies have quantitatively measured the impact of these barriers. This study investigated the time elapsed since a person's most recent eye examination (TLEE) as a measure of barriers to eye care. METHODS: Participants (N=1699) from mobile clinic vision health screenings completed demographic and subjective visual function questionnaires, and then underwent comprehensive eye exams. Associations between demographics, subjective visual function, and visual acuity were analyzed with respect to TLEE. RESULTS: Many Hispanic (34.9%) and uninsured (28.6%) participants had no previous eye exam. Although most Caucasians had a previous eye exam, 40.2% did not have an exam in the previous four years. The majority of participants with diabetes were non-compliant with recommendations of annual eye examinations. CONCLUSION: These results describe barriers that are specific to subpopulations, providing useful information for efforts to improve eye care access.

Climate change and microbiological water quality at California beaches.

Daily microbiological water quality and precipitation data spanning 6 years were collected from monitoring stations at southern California beaches. Daily precipitation projected for the twenty-first century was derived from downscaled CNRM CM3 global climate model. A time series model of Enterococcus concentrations that was driven by precipitation, matched the general trend of empirical water quality data; there was a positive association between precipitation and microbiological water contamination (P < 0.001). Future projections of precipitation result in a decrease in predicted Enterococcus levels through the majority of the twenty-first century. Nevertheless, variability of storminess due to climate change calls for innovative adaptation and surveillance strategies.

Influence of variable precipitation on coastal water quality in southern California.

OBJECTIVES: To examine the consequences of changing precipitation levels on southern California's recreational coastal water quality, and compare the responses of watersheds with differing levels of urban development. METHODS: The geo-temporal relationship for six years (2000-2005) of precipitation levels, discharge rates for the ten primary waterways, and coastal water bacteria concentrations at seventy-eight southern California beaches were examined. RESULTS: Precipitation levels, river-creek discharge rates, and coastal water bacteria concentrations were significantly correlated (p < 0.01) for all ten watersheds investigated. Water bacteria concentrations significantly increased with higher levels of precipitation across 95% of the seventy-eight beaches investigated. A heavily developed watershed had significantly higher median bacteria concentrations (186 cfu) in the adjoining coastal waters compared to an undeveloped watershed (10 cfu) of similar size. CONCLUSIONS: Precipitation and ensuing runoff strongly control the rate of polluted water delivered to most beaches in southern California. Variable precipitation generates a greater response in coastal water bacteria concentrations in developed watersheds compared to undeveloped areas. Projected declines in regional precipitation as a consequence of climate change may result in less contaminated water delivered to coastal waters, thus decreasing risk of water associated illnesses during winter months.

Health risk of bathing in Southern California coastal waters.

Urbanized areas often discharge large volumes of contaminated waste into coastal waters, which may pose a health risk to bathers at nearby beach areas. In this investigation the authors estimated the number of gastrointestinal and respiratory illness episodes associated with the microbial contamination of coastal waters among bathers at Southern California beaches from 2000 through 2004. Bathers at the 67 beaches along the 350-km coastline of Southern California were the study population in this investigation. The authors' estimates were derived from a simulation model, which utilized water quality, beach attendance, and bathing-rate data, along with the three concentration-response relationships that underlie US Environmental Protection Agency, World Health Organization, and European Union marine water-quality guidelines. Given the absence of a general surveillance program to monitor these illnesses in Southern California, simulation modeling provides an established method to derive health risk estimates, despite additional analytic uncertainty that may accompany modeling-based analyses. An estimated 689,000 to 4,003,000 gastrointestinal illness episodes and 693,000 respiratory illness episodes occurred each year. The majority of illnesses (57% to 80%) occurred during the summer season as a result of large seasonal increases in beach attendance and bathing rates. As 71% of gastroenteritis episodes were estimated to occur when the water quality was considered safe for bathing, California's marine water-contact standards may be inadequate to protect the health of bathers.