ABSTRACT
Purpose : COVID-19 has disrupted provision of and access to healthcare. Children newly diagnosed with uveitis are particularly vulnerable to these disruptions. We aimed to describe the impact of the pandemic on the experiences and perceptions of care use for families of children newly diagnosed with uveitis. Methods : UNICORNS-C19 is a cross-sectional study embedded within the Uveitis in Childhood National Prospective Cohort Study (UNICORNS), which is recruiting UK children with non-infectious uveitis in order to understand the sociodemographic, clinical and biological determinants of disease and treatment outcomes and quality of life. We distributed (postally and electronically) a modified Health Foundation / Ipsos Mori survey, which comprises 13 questions (closed and open) around health and social care. Quantitative data were analysed using descriptive statistics, free text responses were analysed using qualitative thematic analysis. A framework was developed to index and chart data into themes through an iterative process. Results : Response rate to date is 42 of the 95 UNICORNS families approached (44%). Of those who participated, 61% expressed concern over the impact of the pandemic on their health, with a third (31%) expressing difficulties in accessing essential medication, and 56% finding it harder to get basic food stuffs. Despite this, the majority expressed a positive experience with NHS services, with 72% being comfortable using their specialist hospital during the pandemic. Key themes identified in analysis included positive experiences of safety procedures and the adoption of digital health tools across different levels of care (primary to quaternary);negative experiences of poor co-ordination of care, or of delivery of synchronous telemedicine care of rare disease from primary / secondary health teams, and negative perceptions around the use of immunosuppression during the pandemic. Conclusions : The UNICORNS study is well placed to provide useful data on patient experience for those starting a rare, chronic childhood disease care pathway during a global pandemic. Our findings suggest that primary and secondary care teams require additional support in delivering / co-ordinating care for those with rare disease. UNICORN C-19 findings will inform recommendations for future service planning.
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.