Determinants of non-attendance in asynchronous telemedicine ophthalmology clinics

Abstract

Purpose : Ophthalmic services are facing unprecedented pressures. Telemedicine has emerged as a potential solution to increase healthcare accessibility to a greater number of patients. This has been particularly emphasised by the COVID-19 pandemic, where digital health facilitated the provision of ophthalmic services in the face of strained resources, widespread service cancellations and social distancing restrictions. Thus, telemedicine has proven itself to be an invaluable resource. However, greater reliance on digital technology may further exacerbate healthcare inequalities faced by certain populations. The purpose of our study was to determine factors associated with non-attendance at asynchronous tele-ophthalmic clinics.

Methods : This was a retrospective cohort study that reviewed all patients newly referred to Moorfields Eye Hospital (MEH) in London, United Kingdom, between January 1st 2019 and October 31st 2021. Electronic healthcare records were used to extract sociodemographic information, clinical variables and appointment details. The primary outcome measure was attendance at asynchronous clinics. 'Asynchronous' is the approach in which the patient attends for in-person assessment and/or imaging by technician with subsequent review of results by a clinician. Multivariable logistic regression modelling was used to examine attendance status against sociodemographic, clinical and operational exposure variables.

Results : A total of 8878 eligible patients (median age 57±20 years, 52% female) attended asynchronous clinics across all MEH sites in the defined time period. Non-attendance was 11.7%. All asynchronous clinics were either medical retina (n=2740) or glaucoma (n=6138). Medical retina patients had 61% less odds (p<0.001) of attending their appointment compared to those attending the glaucoma service. Patients with diabetes (adjusted OR 2.16, CI 1.70-2.75) and registered sight impairment (OR 1.53, CI 0.35-6.60) were more likely to attend. Male sex (OR 0.78, CI 0.68-0.89) and greater levels of socioeconomic deprivation (OR 0.92, CI 0.90-0.95) were associated with increased rates of non-attendance.

Conclusions : Male sex and socioeconomic deprivation are associated with greater rates of non-attendance at asynchronous teleophthalmic clinics. Further study into the identified factors associated with poor attendance may determine potential solutions and improve healthcare provision in these populations.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.