RT Journal Article
SR Electronic
T1 Determinants of non-attendance at face-to-face and telemedicine ophthalmic consultations
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP bjo-2022-322389
DO 10.1136/bjo-2022-322389
A1 Siegfried K Wagner
A1 Laxmi Raja
A1 Mario Cortina-Borja
A1 Josef Huemer
A1 Robbert Struyven
A1 Pearse A Keane
A1 Konstantinos Balaskas
A1 Dawn A Sim
A1 Peter B M Thomas
A1 Jugnoo S Rahi
A1 Ameenat Lola Solebo
A1 Swan Kang
YR 2023
UL http://bjo.bmj.com/content/early/2023/05/22/bjo-2022-322389.abstract
AB Background/aims Evaluation of telemedicine care models has highlighted its potential for exacerbating healthcare inequalities. This study seeks to identify and characterise factors associated with non-attendance across face-to-face and telemedicine outpatient appointments.Methods A retrospective cohort study at a tertiary-level ophthalmic institution in the UK, between 1 January 2019 and 31 October 2021. Logistic regression modelled non-attendance against sociodemographic, clinical and operational exposure variables for all new patient registrations across five delivery modes: asynchronous, synchronous telephone, synchronous audiovisual and face to face prior to the pandemic and face to face during the pandemic.Results A total of 85 924 patients (median age 55 years, 54.4% female) were newly registered. Non-attendance differed significantly by delivery mode: (9.0% face to face prepandemic, 10.5% face to face during the pandemic, 11.7% asynchronous and 7.8%, synchronous during pandemic). Male sex, greater levels of deprivation, a previously cancelled appointment and not self-reporting ethnicity were strongly associated with non-attendance across all delivery modes. Individuals identifying as black ethnicity had worse attendance in synchronous audiovisual clinics (adjusted OR 4.24, 95% CI 1.59 to 11.28) but not asynchronous. Those not self-reporting their ethnicity were from more deprived backgrounds, had worse broadband access and had significantly higher non-attendance across all modes (all p<0.001).Conclusion Persistent non-attendance among underserved populations attending telemedicine appointments highlights the challenge digital transformation faces for reducing healthcare inequalities. Implementation of new programmes should be accompanied by investigation into the differential health outcomes of vulnerable populations.No data are available.