Determinants of Non-Attendance in Face-to-Face Ophthalmic Clinics Pre- and During the Coronavirus Pandemic

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.