ABSTRACT
Purpose : The COVID-19 pandemic has accelerated the introduction and dissemination of telemedicine into ophthalmic secondary care. Yet this pivot to telemedicine-dominated care could exacerbate the differential in health outcomes for certain groups. This study seeks to quantify and characterise factors associated with non-attendance within a population of patients attending synchronous tele-ophthalmic hospital outpatient appointments. Methods : A retrospective cohort study at a tertiary-level ophthalmic institution comprising a principal central site, four district hubs and five satellite clinics in London, UK between January 1st 2019 and October 31st 2021. Multivariable logistic regression modeled attendance status against sociodemographic, clinical and operational exposure variables for all new patient registrations. Results : Between January 1st 2019 and October 31st 2021, a total of 6843 eligible patients (mean age of 45 +/- 32, 58.0% female) were newly registered to attend synchronous teleophthalmology clinics. Self-reported ethnicity identified 3.4% as South Asian, 1.4% Black, 25.3% Other Ethnic Group and 7.6% White. 62.3% did not report their ethnicity. Most appointments were in general ophthalmology (59.9%, n=4096), followed by cataract (20.2%, n=1379), adnexal (19.1%, n=1310), medica retina (0.1%,n=55) and glaucoma (0.0%,n=3). Increased rates of non-attendance were associated with male sex (adjusted OR 0.74, CI 0.62-0.88), greater levels of deprivation (adjusted OR 0.88, CI 0.84-0.92), incompletion of self-reported ethnicity (adjusted odds ratio 0.3, CI 0.17-0.54) and a previously cancelled appointment (adjusted OR 0.65, CI 0.5-0.83) (all p<0.001). Individuals identifying as Asian or Black ethnicity had worse attendance in synchronous clinics with adjusted odds ratios of 0.42 (CI 0.20-0.90, p = 0.02) and 0.28 (CI 0.12-0.65, p=0.0025) respectively. Patients with diabetes were more likely to attend with an adjusted odds ratio of 1.03 (CI 0.3-3.55, p = 0.9). Conclusions : With regards to synchronous teleophthalmology clinics, poorer attendance is associated with male sex, greater socioeconomic deprivation and self-reported Asian and Black ethnicities. Further study is warranted to evaluate whether enhanced surveillance of these cohorts could improve their non-attendance rates.
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 nonattendance 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.
ABSTRACT
Purpose : Previous evidence suggests serial 'non-attenders' to clinic appointments are more likely to be socially disadvantaged, afflicted by poor health, and have higher use of emergency healthcare. This report seeks to quantify and characterise factors associated with non-attendance within a population of patients for face-to-face (F2F) outpatient appointments, pre-and during the COVID-19 pandemic. Methods : This was a retrospective cohort study of all National Health Service (NHS) patients, aged 18 and over, who were newly referred to Moorfields Eye Hospital NHS Foundation Trust, a tertiary ophthalmic institution consisting of a principal central site, four district hubs and five satellite clinics in London between January 1st 2019 and November 1st 2021. We included patients referred to the adnexal, cataract, general ophthalmology, glaucoma and medical retina services. Only the patient's first encounter (attendance or non-attendance) with MEH was included. Results : A total of 70,328 of first appointments were F2F (mean age pre-pandemic: 54 and pandemic: 56-IQR: 30 for both cohorts). The non-attendance rates for face-to-face pre-pandemic were 9.0% and face-to-face pandemic were 10.5%. Male sex (adjusted odds ratio pre-pandemic: 0.85, 0.80-0.91 and pandemic: 0.89, 0.82-0.97), greater levels of deprivation (adjusted odds ratio pre-pandemic: 0.89, 0.88-0.91 and pandemic: 0.91, 0.90- 0.93), incompletion of self-reported ethnicity and a previously cancelled appointment (whether instigated by the hospital or patient) were strongly associated with non-attendance within this mode of care delivery (p<0.01). Conclusions : Overall, male sex and greater socioeconomic deprivation are associated with poorer attendance. More specifically, non-attendance was higher amongst patients with self-reported Black ethnicity and early morning appointment times. Older patients, self-reported Caucasian ethnicity, those with diabetes and later appointment times were associated with higher levels of attendance. Further study is warranted to evaluate whether enhanced surveillance of certain cohorts could improve non-attendance rates in these groups.
ABSTRACT
Purpose : Moorfields Eye Hospital, London, is a centre of excellence for ophthalmic research, education and patient care. During the COVID-19 pandemic, medical students' clinical education exposure and patients' multidisciplinary care were greatly affected. Telepresence robots have been suggested as a solution to reduce the impact of COVID-19. We present the results of a trial used to evaluate the capabilities of a telepresence robot in improving clinical education for undergraduate medical students, and the possibility to deliver multidisciplinary clinical patient care via a telepresence robot. Methods : In a two-day trial period, the telepresence robot was used in four tasks: 1) to livestream an adnexal surgery to students off-site;2) autonomously navigating patients from clinic to pharmacy;3) by a clinician to remotely review patients with an ophthalmologist who was consulting the patient face to face;4) and to deliver a teaching session to medical students. Feedback was gathered using a questionnaire and in a group discussion together with clinicians, patients, students, robot specialists and IT specialists. Results : 15 patients of a wide age range and 5 medical students were surveyed. The vast majority of both groups were unaware of telepresence robots. The mean rating given by both groups was 6/10 (with a range of 1-10/10 and 3-8/10) respectively. The groups praised the innovation, felt it could support clinical pressures, and improve their involvement. However, there were concerns about impersonality and technical limitations, and each offered ideas for improvements. All students felt there was potential to improve medical education using the robot. Qualitative feedback during the group discussion highlighted the importance of adapting the currently available hardware and software to enhance its use in education and patient care. Conclusions : This trial provided a greater understanding into the practicalities of incorporating a telepresence robot, in its current form, to clinical medical care and education. While there are challenges with the technical specification of the telepresence robot, the proposition of using such a device has drawn positive engagement from students, patients and clinicians thus validating further research.
ABSTRACT
The novel coronavirus outbreak was first reported in late December 2019 and more than 7 million people were infected with this disease and over 0.40 million worldwide lost their lives. The first case was diagnosed on 30 January 2020 in India and the figure crossed 0.24 million as of 6 June 2020. This paper presents a detailed study of recently developed forecasting models and predicts the number of confirmed, recovered, and death cases in India caused by COVID-19. The correlation coefficients and multiple linear regression applied for prediction and autocorrelation and autoregression have been used to improve the accuracy. The predicted number of cases shows a good agreement with 0.9992 R-squared score to the actual values. The finding suggests that lockdown and social distancing are two important factors that can help to suppress the increasing spread rate of COVID-19. © 2018 Tsinghua University Press.