Abstract
Purpose :
The use of video consultations was scaled urgently at Moorfields Eye Hospital due the COVID-19 pandemic, and has been sustained within the Trust. This provision was much needed and initiated without the usual stakeholder engagement. Digital exclusion will drive health inequalities in our patients, unless we fully understand it and create solutions to make our services accessible for all. The aim of the project is to understand the reasons why patients failed to utilise digital services during the pandemic.
Methods :
A retrospective analysis of all patient-initiated video consultation cancellations from December 2020 to November 2021 was undertaken. All rebooked appointments were excluded from analysis. Reasons for cancellation were extracted from the Patient Appointment System (PAS) to identify those who were digitally excluded. Patients who had opted out of data sharing or cancelled their video consultation but had attended another subsequent appointment were excluded from the analysis for digital exclusion.
Results :
Over a 1-year period, 10,457 video consultations were undertaken at Moorfields Eye Hospital. 5% (535) of appointments were cancelled by patients. Of these, 14% (73 patients) were digitally excluded. Digital exclusion was due to 3 main factors; lack of resources (53%), lack of skills (19%), lack of trust in the video consultation model (19%), or a combination of these factors (9%).
The age range of digitally excluded patients was 9 to 89 years old. Those most digitally excluded were the 70-79 year olds (26%, 19 patients). The least digitally excluded age group were the 20-29 years olds (1%, 1 patient).
In terms of sub-speciality, 52% (38 patients) were from the adnexal service, 27% (20 patients) from general ophthalmology, 12% (9 patients) from paediatric ophthalmology, and the remainder from ocular oncology (4%), strabismus (3%) and medical retina (1%).
Conclusions :
The reasons for digital exclusion are complex, but need to be understood and addressed, if we are to continue to scale digital services in the health sector and without widening health inequalities. Our work identified 3 main factors, with lack of resources being the overarching reason. Further implementation research in the fields of digital resource provision coupled with education may enable greater inclusion of this group of patients and enhance digital healthcare provision equality.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.