Determinants of non-attendance in synchronous teleophthalmology clinics

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.