Hospital Appointments Research Articles

A Solution to Reduce the Impact of Patients' No-Show Behavior on Hospital Operating Costs: Artificial Intelligence-Based Appointment System.

Patient no-show behavior is a critical factor complicating hospital resource optimization and causing waste. The inefficiency caused by patients' no-shows and the resulting increased operating costs negatively affect the hospitals' financial structure and service quality. For this reason, health managers must make accurate predictions about whether patients will attend an appointment and plan the appointment system within the framework of these predictions. This research aims to optimize the hospital appointment system by making accurate predictions regarding the no-show behavior of the patients, based on recorded data. An artificial intelligence-based appointment system has been developed according to patients' demographics and past behavior patterns. The forecast results and realized performance results were compared. The artificial intelligence we have developed continuously improves appointment assignments by learning from past and current data. According to the findings, the artificial intelligence-based appointment system increased the rate of patients attending appointments by 10% per month. Likewise, the hospital capacity utilization rate increased by 6%. Findings from the study confirmed that no-show risks could be managed in the appointment process through artificial intelligence. This artificial intelligence-based design for appointment systems significantly decreases hospital costs and improves service quality performance.

The scanning CONfoCal Ophthalmoscopy foR DIAbetic eye screening (CONCORDIA) study paper 2.

To determine if the Eidon white light 60-degree field Scanning Confocal Ophthalmoscope (SCO) camera was safe to use with staged mydriasis in a Diabetic Eye Screening Programme (DESP). The trial participants were recruited from people with diabetes attending appointments in DESP or Virtual Eye clinics for post-Covid delayed hospital appointments. Using staged mydriasis, the SCO images were taken before the pupils were dilated and compared to two-field 45 degrees mydriatic digital photography (the reference standard). Mydriatic SCO images were only compared to the reference standard if the non-mydriatic SCO images were unassessable. 1050 patients were recruited, 35 individuals were withdrawn, the majority (18) due to an imaging protocol deviation leaving 1015 individuals (2029 eyes). Using staged mydriasis, the sensitivity and specificity for any retinopathy was 97.5% (95% CI: 96.4-98.4%) and 82.3% (95% CI: 79.6-84.7%) respectively. The sensitivity and specificity for referable retinopathy was 92.7% (95% CI: 89.9-94.9%) and 85.4% (95% CI: 83.6-87.2%) respectively. The total number of eyes that were unassessable with the Eidon without mydriasis was 85/2029 (4.2%), and after mydriasis was 34/2029 (1.7%) and, with the reference standard, 34/2029 (1.7% - not always the same images) were unassessable. This study provides promising early results of the performance of the Eidon camera using staged mydriasis in a DESP which needs further evidence from a non-Caucasian population and from cost-effectiveness analyses.

Impact of care coordination on service utilisation for children with medically complex cerebral palsy.

Complex care programmes for children with medically complex cerebral palsy (CP) exist; however, evidence for their impact is limited. This study (i) explored the impact of The Royal Children's Hospital Complex Care Hub (CCH) on hospital service utilisation rates over a 3-year period for children with medically complex CP compared with those eligible but received routine care, and (ii) compared health, disability and socio-demographic characteristics of children and their families in both groups. Electronic medical record data from 78 children (mean age 9.43 years, females n = 37) with medically complex CP who accessed CCH services, and 92 (mean age 10.86 years, females, n = 39) who received routine care were included. Multivariable regression was used to analyse service utilisation: number of emergency department (ED) presentations, length/number of inpatient and intensive care unit admissions and number/type of hospital appointments. Critical health-care needs, functioning/disability profile and child/family demographics for each group were compared. More children in the CCH group had a mixed motor type (73.1% vs. 15.2%), were classified within Gross Motor Function Classification System level V (76.9% vs. 34.8%), had respiratory, nutrition and social support needs and epilepsy. Children receiving CCH services had higher service utilisation rates; ED presentations (rate ratio (RR) = 1.81, 95% confidence interval (CI): 1.09-3.01), inpatient admissions (RR = 2.77, 95% CI: 2.01-3.83), outpatient encounters (RR = 1.69, 95% CI: 1.31-2.18) and telephone encounters (RR = 6.05, 95% CI: 4.56-8.02). Children with medically complex CP accessing a complex care service have higher service utilisation rates yet have more complex clinical presentations and higher support needs.

Quality of Life and Complications Among Hemodialysis Patients.

Background Patients with renal impairment who require frequent hospitalizations or dialysis must undergo the rigorous process known as hemodialysis (HD). Hemodialysis is a complex treatment for people who require frequent hospital or dialysis appointments, typically three times each week. We aim to explore the quality of life of hemodialysis patients and their complications. Methodology This case-control study focuses on renal failure patients in Riyadh's hemodialysis units. The case group included 50 hemodialysis patients with 50 healthy individuals medically free in the control group who were the same gender and age as the case group. The comparison was made using a quality of life (QoL) short form 36 questionnaire conducted by a trained physician via Google Forms. The data was obtained in February and March 2023. Results The majority of participants were male (68; 68%), aged 40-50 years (42; 42%), 53 (53%) were non-Saudi, 76 (76%) began hemodialysis one year ago, and 30 (30%) developed an infection as a complication. There was a significant statistical relationship between our results and the results of a medical outcome study in the emotional problem and energy/fatigue domains. Conclusion In all domains, HD patients performed worse on subscales than healthy people of the same age and socioeconomic status. The average QoL score for HD patients was lower than that of healthy individuals. There was a statistically significant relationship between healthy people and hemodialysis patients in two domains: emotional problems and energy/fatigue levels.

The Scanning CONfoCal Ophthalmoscopy foR DIAbetic eye screening (CONCORDIA) study paper 1.

This project was to determine the performance of the Zeiss Clarus 700 (Clarus) and the Optos California (Optos) with staged mydriasis in a Diabetic Eye Screening Programme (DESP). Trial participants were recruited from people attending appointments in DESP or Virtual Eye clinics for delayed hospital appointments. Non-mydriatic photographs from the Clarus and Optos cameras were compared to 2-field 45 degrees mydriatic digital photography (the reference standard) and mydriatic photographs compared if the non-mydriatic photos were unassessable (staged mydriasis). 1573 patients were recruited. 76 individuals were withdrawn, leaving 1497 individuals (2993 eyes). For the Clarus and the Optos, the sensitivity for any retinopathy were 94.2% (95% CI: 92.9-95.3%) and 91.9% (95% CI: 90.5-93.2%) with specificities of 87.3% (95% CI: 85.4-89.0%) and 78.1% (95% CI: 75.7-80.3%) respectively. For referable DR the sensitivities for the Clarus and Optos were 86.0% (95% CI: 82.9-88.8%) and 77.6% (95% CI: 73.9-80.9%) with specificities of 92.8% (95% CI: 91.7-93.8%) and 95.4% (95% CI: 94.5-96.2%) respectively. The Clarus and Optos without mydriasis produced 100 (3.3%) and 152 (5.1%) unassessable eyes respectively, and after staged mydriasis 51 (1.7%) and 102 (3.4%) respectively with 52 (1.7%) reference standard images unassessable. This study reports the performance of the Clarus and the Optos using staged mydriasis in DR screening with wider fields detecting more referable retinopathy peripherally with some reduction in sensitivity centrally for macular lesions.

332 - Predictors of missed hospital appointments in patients with posterior compartment pelvic floor disorders in a tertiary referral center

332 - Predictors of missed hospital appointments in patients with posterior compartment pelvic floor disorders in a tertiary referral center

Effectiveness of Personalised Phone Calls and Short Message Service Reminders in Improving Patient Attendance at a Radiology Department.

Patients missing scheduled hospital appointments posesignificant challenges, including resource waste and delayed patient care. This study evaluated the effectiveness of personalised reminder systems (phone calls andshortmessageservice (SMS)) in improving patient attendance rates at a radiology department. The study was conducted at a hospital facility in Saudi Arabia. The intervention involved reminding 493 patients of their radiology appointments using their preferred method (phone call or SMS). Demographic, clinical, and other factors were considered in analysing the impact of these reminders on appointment attendance. Attendance rates before the intervention were further compared with attendance rates after the intervention to assess the effectiveness of the studied strategies. Patient reminders affected overall patient attendance, with a 5% improvement compared to the attendance rates before the intervention. Phone call reminders were found to be more effective than SMS, particularly among older patients (41-60 years). The attendance rate for patients receiving phone call reminders ranged from 35% to 85%, whereas those receiving SMS reminders had a 15-65% attendance range. The study indicated marital status and distance as key factors associated with attendance. Chi-square analysis also highlighted significant differences in attendance rates before and after the intervention, particularly among female patients, single and divorced individuals, and those with at least secondary education. Patients living more than 35 km from the hospital and those referred from other hospitals were more likely to miss appointments, irrespective of the intervention. Personalised phone call reminders seem to be more effective than SMS in reducing missed appointments, especially among older patients. This study highlighted the importance of considering patient demographics and preferences in designing reminder systems to enhance healthcare appointment adherence.

Impact of Technical Support and Information Provision on Patient No-show Behavior

Patient no-shows pose a significant challenge in healthcare operations, disrupting appointment schedules and affecting overall efficiency. Effectively addressing the challenge of reducing patient no-shows is crucial for outpatient service management. This study evaluates how the design of appointment systems affects patient no-show behavior. Using a difference-in-differences methodology, we analyze the effects of two appointment system update events—technical support and information provision—at a Chinese hospital. Our analysis reveals that technical support and information provision are associated with average reductions of 22.40% and 10.91%, respectively. To investigate the mechanisms behind these effects, we conduct a randomized controlled experiment with 233 participants. Our findings reveal that perceived effort and credibility mediate the relationship between information provision and patient no-shows. However, for technical support, only perceived credibility acts as a mediator. This study provides valuable insights for healthcare operations, offering design recommendations to address no-show behavior in hospital appointment systems.

Autogenic training for chronic health conditions: A service evaluation.

Autogenic training (AT) is a structured meditative-style practice, consisting of a sequence of simple mental exercises intended to induce a relaxed state in patients. There is some emerging evidence to suggest that AT can be effective in treating certain chronic conditions, however, further evidence is required. A service evaluation of AT services at the Royal London Hospital for Integrated Medicine was conducted to evaluate the impact of AT on patients with chronic conditions. The service evaluation consisted of the completion of validated quantitative outcome measures pre and posttreatment to explore the impact of AT. AT patients were asked to complete the Measure Yourself Medical Outcomes Profile (MYMOP) and Perceived Stress Scale (PSS) at their first hospital appointment (baseline) and then again 8 weeks later following completion of their AT sessions. Pre- and posttreatment scores for each outcome measure were analysed in SPSS using the Wilcoxon signed-rank test. One hundred ninety-nine patients completed both initial and follow-up MYMOP forms and were included in the evaluation. The most common presenting complaints for MYMOP symptom 1 were prolonged anxiety/stress and depression (n = 70, 35.2%), chronic pain and migraine headache (n = 44, 22.1%), chronic insomnia and sleep problems (n = 42, 21.1%) and, long-term exhaustion and fatigue (n = 18, 9%). The change in median score pre- and posttreatment for all MYMOP categories (symptoms, activity and well-being) were statistically highly significant p < 0.001. Anxiety, stress, depression, pain and insomnia were the symptoms that had the largest statistically significant difference between the median score pre- and posttreatment. Fifty-five patients completed the PSS questionnaire at two time points (pre- and posttreatment). It showed a highly statistically significant change in PSS median score in patients experiencing stress (p < 0.001). The findings of the evaluation indicate that 8 weeks of AT appears to be effective in improving symptoms of concern to patients and enhancing patients' overall well-being. In particular, AT was found to be beneficial for patients with symptoms of anxiety, stress, depression, pain and insomnia.

Outpatient Consultation of Diabetes and Cardiovascular Diseases Patients in Abuja Public Hospitals Based on Selected Indicators

AIM. Diabetes and cardiovascular diseases are among the reasons for most outpatient consultations. The study aimed to evaluate the reported experiences of patients being managed for diabetes and cardiovascular diseases in the outpatient clinics of Abuja public hospitals. METHOD. A prospective cross-sectional study of 787 systematically sampled patients receiving care in five public hospitals in Abuja was conducted. A structured questionnaire was used to collect data on the number of yearly consultations, problems encountered in accessing trained health personnel, time spent on hospital appointments, major treatment challenges, and ways to improve their experience on hospital visits. Consultation experience was defined as good or poor. Patients who consulted at least four times in a year, reported no problems in accessing trained health personnel, and had no treatment challenges were regarded as having a good consultation experience. Frequency, percentage, mean, and standard deviation were used to summarize the data. Logistic regression was used to predict and classify the binary outcomes. A p-value ≤ 0.05 was considered significant. RESULTS. More of the patients (66.2%) had up to four consultations in a year. Long waiting time (56.1%) was the common problem encountered when accessing trained medical personnel. The major treatment challenge was hospital waiting time (49.4%). The mean time spent in the hospital on appointment days was 5.04±1.80. Approximately 40% of the patients suggested proper scheduling of hospital appointments as the major way to improve treatment experiences. Poor consultation was recorded by 96.6% of the patients. Logistic regression showed that a higher educational level (OR = 0.031, 95% CI [0.008-0.119], _P=_0.001) was associated with reporting poor management. CONCLUSION. The average number of yearly consultations was below the minimum standard, and patients spent long hours on consultation days before meeting with healthcare personnel. Most patients were dissatisfied with the services received and rated them poor.

How did the COVID-19 pandemic affect cancer patients in England who had hospital appointments cancelled?

How did the COVID-19 pandemic affect cancer patients in England who had hospital appointments cancelled?

NGO Automation Suite with RPA

Abstract: The COVID-19 outbreak has forced every NGO to operate with reduced manpower and facing lot of operational challenges. Every NGO is trying to automate end to end process of campaign outreach, Donation management, Report generation, KYC Verification and Customer email query automation. This virtual registration experience will help NGO to collect, manage and update registration details easily for multiple campaigns. User will receive automated email with KYC verification, Hospital Appointment and Certificate of Appreciation.

Assessment of Outpatient Management of Diabetes and Cardiovascular Diseases in Abuja Public Hospitals

AIM. Diabetes and cardiovascular diseases are among the reasons for most outpatient consultations. The study aimed to evaluate the reported experiences of patients being managed for diabetes and cardiovascular diseases in the outpatient clinics of Abuja public hospitals. METHOD. A prospective cross-sectional study of 787 systematically sampled patients receiving care in five public hospitals in Abuja was conducted. A structured questionnaire was used to collect data on the number of yearly consultations, problems encountered in accessing trained health personnel, time spent on hospital appointments, major treatment challenges, and ways to improve their experience on hospital visits. Management experience was defined as good or poor. Patients who consulted at least four times in a year, reported no problems in accessing trained health personnel, and had no treatment challenges were regarded as having a good management experience. Frequency, percentage, mean, and standard deviation were used to summarize the data. Logistic regression was used to predict and classify the binary outcomes. A p-value ≤ 0.05 was considered significant. RESULTS. More of the patients (66.2%) had up to four consultations in a year. Long waiting time (56.1%) was the common problem encountered when accessing trained medical personnel. The major treatment challenge was hospital waiting time (49.4%). The mean time spent in the hospital on appointment days was 5.04±1.80. Approximately 40% of the patients suggested proper scheduling of hospital appointments as the major way to improve treatment experiences. Poor management was recorded by 96.6% of the patients. Logistic regression showed that a higher educational level (OR = 0.031, 95% CI [0.008-0.119], _P=_0.001) was associated with reporting poor management. CONCLUSION. The average number of yearly consultations was below the minimum standard, and patients spent long hours on consultation days before meeting with healthcare personnel. Most patients were dissatisfied with the services received and rated them poor.

Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review.

Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.

Oral and dental health promotion for children's nurses.

Tooth decay remains one of the most common preventable oral health concerns in children. After birth, advice to caregivers predominantly focuses on medical health with little attention paid to dental health. Before discharge from the maternity unit and during future hospital and community appointments, opportunistic dental advice should be provided by midwives, nurses and health visitors where possible, with the aim of preventing early onset dental disease. Registering with a dentist at birth is crucial due to long NHS dental waiting lists. Simple advice on toothbrushing should be offered, including brushing twice a day with a soft toothbrush using an age-appropriate amount of fluoride toothpaste. Mothers should be provided with information on the benefits of breastfeeding for oral health alongside tailored preventive care. Appropriate advice on bottle-feeding and weaning is required, including minimising the use of added sugar, drinking from free-flow cups after six months of age, and discouraging the use of milk bottles at bedtime and in general after one year of age. Written visual summaries can be shared with parents to consolidate verbal advice on oral and dental health.

Profile of hospitalised maltreated children aged 0 to 3 years and their families.

Maltreatment adversely affects children's health and development. Knowledge of child maltreatment in early childhood is limited. We studied the demographic factors and health issues in children aged 0-3 years who were hospitalised for maltreatment. In this retrospective cohort study, health and demographic information was extracted from the electronic medical records of children hospitalised in KK Women's and Children's Hospital between January 2018 and June 2019. High-risk groups were children with developmental delay (DD), missed vaccination (MV), low outpatient attendance, high dependency unit (HDU) or intensive care unit (ICU) admission and Child Protection Service (CPS) referral. Chi-square or Fisher's exact test was used for categorical variables. Mann-Whitney U test was used for skewed quantitative variables. Among the 101 children included in the study, the most common type of abuse and alleged perpetrator were physical abuse and parents, respectively. In addition, 35.6% of the children had pre-existing health conditions before hospitalisation, 58.4% had new health conditions diagnosed during hospitalisation requiring follow-up and 26.7% had maltreatment-related injuries. One-fifth of the children had DDs and another one-fifth had MVs. About 20% of them had defaulted all outpatient appointments. High-risk children mostly lived in rented housing. Their mothers mostly had primary education or lower. Most children admitted to ICU or HDU were <6 months old (8/12 [66.7%] vs. 6-24 months 3/12 [25%] vs. 24-47 months 1/12 [8.3%], P = 0.001). A higher number of children with DD were referred to CPS (63.2%, P = 0.049) than to other agencies. Maltreated children have significant health needs that are not fully met through routine surveillance practices. They are at risk of defaulting their hospital appointment. It is imperative that families at risk of child maltreatment are identified early and their needs holistically evaluated, with care coordinated within the hospital-community support system.

Caredoc Community Intervention Teams - Multidisciplinary Approaches to Delivering Care in the Community

Introduction: Caredoc Community Intervention Team (CIT) has been operating for 10 years and during that time has expanded its service to cover 6 regions in the South East of Ireland. A central objective of the service is delivering holistic and integrated care in the community that meets the needs of patients and their families. In 2021 the service model was enhanced to include Occupational Therapy and Physiotherapy professionals to the team to work collaboratively with Nursing colleagues, thereby reducing multiple hospital appointments and supporting early discharge from acute hospitals and community rehabilitation, particularly for elderly and clinically vulnerable patients, by shifting delivery of multidisciplinary care to patient’s homes.&#x0D; Aims, Objectives, Theory Or Methods: The CIT service is deployed 7 days a week, 365 days a year and bridges the gap between acute care and the patients who require it by providing access to timely, flexible, ongoing and personalised treatment in clients’ own homes for the duration of their illness, thus avoiding hospital admissions and enabling early supported discharge. For patients and their families this offers enormous relief and support, particularly while living with the Covid-19 pandemic, as the service provides a wide range of home-based assistance, from medication management to advice around necessary equipment and changes to the home environment to improve rehabilitation.&#x0D; Highlights Or Results Or Key Findings: Strong linkages with hospital and other community-based teams have been formed to ensure continuity of care for patients and optimisation of key healthcare resources – joint home visits with other CIT professionals involved in individual patients’ care have been coordinated to streamline and improve access to appropriate care. These links have also allowed for the co-design of structured referral pathways from local hospital clinics to the service, enabling the CIT Team to offer care to patients requiring regular monitoring at home, thereby reducing unnecessary hospital visits and supporting earlier supported discharge from acute hospitals. The impact of this interdisciplinary, collaborative approach has been hugely positive on patients’ health and wellbeing along with the additional benefit of decreasing pressure on hospital-based services.&#x0D; Conclusions: The diversity of disciplines within the CIT service ensures that all aspects of a patient’s recovery is managed, and the team’s on-going and effective communication strives to optimise individual treatment plans to achieve stabilisations, ensure patient safety, avoid hospital admission and enable supported earlier discharge. The team also provides acute nursing services to patients discharged to residential care, with the overall effect of increasing capacity and bed availability in local hospitals.&#x0D; Implications For Applicability/Transferability, Sustainability And Limitations: In just under a year of service the multidisciplinary CIT team carried out almost 10,000 visits to patient homes – each client referred to the service has an average of 3 encounters with the team, ensuring that multi-faceted reablement is achieved for patients while remaining in their own homes.

A hospital care coordination team intervention for patients with multimorbidity

Objective: To develop and evaluate a hospital care coordination team intervention for patients with multimorbidity and multiple specialists at the outpatient clinic&#x0D; Study setting: A middle-large teaching hospital (542 beds) in the Netherlands&#x0D; Study design: Practice-based, participatory pilot study with mixed-methods, using the Framework for Developing and Evaluating Complex Interventions. The intervention consisted of an intake, a comprehensive review by a dedicated care coordination team, a consultation to discuss results and two follow-up appointments.&#x0D; Data Collection: We included adult patients who had visited seven or more outpatient specialist clinics in 2018. We excluded patients with less than two scheduled hospital appointments or if the potential participant was already receiving coordinated care. We collected quantitative and qualitative data on patient characteristics, number and type of recommendations from the comprehensive review, experiences and short-term outcomes.&#x0D; Principal Findings: 250 patients were assessed for eligibility. We excluded 119 patients, 54 of these patients (21,6%) were deceased at the time of assessment and 28 patients (11,2%) had less than two scheduled appointments. Out of 131 invited patients, 28 participants underwent the intake and comprehensive review. The review produced recommendations for at least two out of three categories (medication, involved medical specialists, other) for 21 participants. Patients’ experienced effects of the intervention ranged from very large to no effect. Identified key uncertainties of the intervention were finding the best suited patient population and the minimum of required data that can be collected with feasible effort during regular clinical care.&#x0D; Conclusions: The developed hospital care coordination team intervention resulted in mixed outputs and short-term outcomes. We learned that recruitment and selection should be refined to include patients with multimorbidity who might benefit most. Outcomes of research and clinical care should align as much as possible and focus on evaluating the result of care coordination first.&#x0D;

The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study

BackgroundThe global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman.MethodsA retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments.ResultsA total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments.ConclusionThe rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.

The Value of Implementing a Digital Approach in the Obstructive Sleep Apnoea Patient Pathway: A Spanish Example

IntroductionContinuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain. Material and methodsA time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1–3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway. ResultsCompared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3h/night and the proportion of individuals defined as adherent increased from 79% to 91%. ConclusionsImplementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes.