Evaluating Ocular Healthcare Accessibility and the Severity of Emergencies during Times of Crisis

Abstract

Background/Objectives: The COVID-19 pandemic has profoundly impacted healthcare systems worldwide, including the delivery of ophthalmic emergency services. This study examines the impact of the COVID-19 pandemic on the clinical presentation of emergencies and the accessibility of healthcare in ophthalmology. Methods: The study employed a single-center, consecutive case series design with historical controls to examine electronic health records over a 21-day period during the COVID-19 pandemic and a matched period from the preceding year. Records were analyzed for demographic variables, diagnosis, length of stay, travel distance, and referral status. The urgency of cases was evaluated by three independent graders using the BaSe SCOrE (BAsic SEverity Score for Common OculaR Emergencies). Results: A total of 1229 patients were included in the study, with 786 patients in the 2019 cohort and 443 patients in the 2020 cohort. During the pandemic period, there was a significant decrease in the number of patients and the duration of their visits (p < 0.0001, p < 0.0001, respectively). There was an increase in walk-in patients (p = 0.03), who took significantly longer journeys to be treated as compared to referred patients (p < 0.01). At the same time, the severity of emergencies increased (p = 0.02). The 2019 logistic regression model found that age (p = 0.003), referral status (p < 0.001), distance (p = 0.009), and first presentation (p = 0.02) were significant predictors of the severity, while gender was not (p = 0.78). The 2020 model found that only age (p < 0.001) and referral status (p < 0.001) were significant predictors of severity. Conclusions: The observed decline in patient volume, increased severity of emergencies, and shifts in predictive variables within the logistic regression models are indicative of significant barriers to healthcare access. Therefore, enhancing health literacy and ensuring low-threshold access to emergency services are crucial, especially during crises.