Non-attendance Rate Research Articles

Primary care optometry-based diabetic retinopathy review clinics - a new model of care and comparison with virtual diabetic retinopathy clinics.

Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics. In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of "ungradable" retinopathy referrals. One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023.954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52-0.69) for DR grade and 0.69(95% CI 0.56-0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics. The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR.

Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively.Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

No-Show Rates in an Academic Otolaryngology Practice Before and During the COVID-19 Pandemic.

Our objectives were to determine the no-show and nonattendance rate for an outpatient academic otolaryngology practice, to identify patient and systemic factors associated with nonattendance, and to evaluate the impact that the COVID-19 pandemic had on the rate of nonattendance. This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multi-physician, academic, general, and sub-specialty otolaryngology practice from January 2019 to December 2021. Over three years, 121,347 clinic visits were scheduled in the otolaryngology practice. The overall nonattendance rate was 18.3%. A statistically significant increase in nonattendance was noted during the COVID-19 pandemic (16.8% vs. 19.8%, p < 0.001). The rate of nonattendance in patients of younger age (under 18 years) (p <0.001), female gender (p=0.03), afternoon appointments (p=0.04), and extended time between the day of scheduling and the day of appointment (p <0.001) increased. Head and neck clinics were found to have the lowest nonattendance rates, while pediatric otolaryngology clinics had the highest (12.6% vs. 21.3%). On multivariate regression, younger age (p < 0.001), female gender (p=0.01), afternoon appointments (p< 0.001), and online self-scheduling (p< 0.001) were significantly associated with nonattendance. Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.

The socio-demographics and clinical profile of patients referred to the GP liaison psychiatry service within a metropolitan Aboriginal medical service.

This study aimed to describe the social demographics and clinical profile of patients referred to the psychiatry service within the local Queensland metropolitan Aboriginal Medical Service (AMS). This was a retrospective cohort study of patients referred to the psychiatry service provided at three clinics of a metropolitan AMS, over an 18-month period. Medical records were accessed to determine demographic and diagnostic information. Diagnostically, 53% of patients had mood/anxiety disorders, 10% psychosis, 23% substance use and 14% with other diagnoses. There was approximately 50% non-attendance rate with no statistical difference between gender and age groups. The highest proportion of non-attenders within age groups was males 45-54years old. The patients needed to travel an average of 20km to attend the AMS. The high non-attendance rates, and proportionately more males within the age group 45-54years who were more likely to not attend their mental health appointments, suggested a target area for outreach services which have been implemented in the AMS. Some of the recommended solutions included confirming attendance the day prior and supporting with transport. This study highlighted the large distance that Aboriginal and Torres Strait Islander people must travel to access culturally appropriate service.

Non-attendance at diabetic retinal screening in Te Tai Tokerau, Northland, Aotearoa New Zealand.

To explore socio-demographic characteristics of non-attenders at diabetic retinal screening. A retrospective, register-based cross-sectional analysis of 10,275 participants invited to diabetic retinal screening in Te Tai Tokerau (Northland) between May 2011 and June 2020 was performed. Multivariable logistic regression analysis was used to assess the association of age, sex, type of diabetes, ethnicity and socio-economic deprivation with non-attendance at diabetic retinal screening. Median age was 66 years and 54.3% of participants were male. The non-attendance rate was 26.4%, with 46.6% of individuals having at least one non-attendance. Younger age was associated with higher odds of non-attendance (OR 1.84 95% CI 1.41-2.40, <0.001 for odds of non-attendance in those aged under 35 years compared with age over 75 years). Māori (OR 2.69, 95% CI 2.44-2.96, p<0.001) and Pacific peoples (OR 1.71, 95% CI 1.25-2.36, p=0.001) had higher odds of non-attendance compared with NZ Europeans. People living in areas of high socio-economic deprivation had higher odds of non-attendance (OR 1.56, 95% CI 1.33-1.82, p<0.001), as did type 1 diabetics (OR 1.31, p5% CI 1.08-1.59, p=0.006). Younger age, socio-economic deprivation, type 1 diabetes and Māori and Pacific ethnicity are risk factors for nonattendance at diabetic retinal screening.

Cost-effectiveness analysis of phone reminders for outpatient magnetic resonance imaging (MRI) appointments in Singapore

IntroductionDue to long wait times, rising demand and limited resources for Magnetic Resonance Imaging (MRI) services, phone call reminders were implemented as an intervention to increase scanner utilisation and improve non-attendance at the radiology department in Changi General Hospital, Singapore. AimThis study aims to evaluate the impact of phone reminders on outpatient MRI non-attendance rate as well as the operational efficiency and savings of this intervention through cost-effectiveness analysis. MethodsMRI outpatient records from January to December 2020 (pre-intervention period) and January to December 2021 (post-intervention period) were retrospectively obtained from the hospital systems. Non-attendance rates, costs and savings following the intervention were compared. ResultsOutpatient appointment non-attendance rates reduced from 12.85% to 8.93% after intervention. Following the phone reminders, 2,953 patients (21.69%) decided to cancel or reschedule their appointments. Based on the 91.07% attendance rate (100% - 8.93%), another 2689 slots were recovered from the cancellation of these appointments and were given to other patients. The reduction in non-attendance rates (3.92%) after the intervention translates to an increase in attendance of 533 patients while the net revenue generation with the phone reminder intervention was $387,179. ConclusionCost analysis indicates that phone reminders provide an inexpensive, easily implemented and personalised method to help increase adherence and improve appointment attendance. Reminding patients by phone calls two day before their appointments also leads to better optimization of appointment slots from cancelations and re-scheduling that can be used to allocate these appointments to other patients.

The 'scan and treat' clinic; early evaluation of an advanced clinical practitioner (ACP) led combined echocardiography and outpatient cardiology clinic

Abstract Funding Acknowledgements Type of funding sources: None. Background There is increasing recognition that traditional models of hospital-based outpatient care in England are inefficient, unsustainable and do meet patient’s needs and preferences (RCP 2018). The National Health Service (NHS) ‘getting it right fist time’ (GIRFT) report for cardiology makes a number of recommendations including; increasing the utilisation non-medical roles such as Advanced Clinical Practitioners (ACPs), reducing face to face appointments, and triaging referrals with tests performed ahead of clinic appointments (NHS, 2021). We developed a novel clinic combining formal echocardiography with clinical assessment by a single British Society of Echocardiography (BSE) accredited ACP at medium sized district general hospital (DGH) in the west Midlands, England. No clinics of this type were identified in the literature, although there are studies demonstrating the efficacy of physiologist led valve clinics (Wasing et al., 2009) and cardiologist led ‘one stop’ clinics (Falces et al., 2008) Purpose To evaluate the case mix and early outcomes of the first 6 months of the scan and treat clinic. Methods Patient demographics, reason for referral and clinic actions were collected prospectively on an excel spreadsheet. A single un-blinded cardiologist reviewed the electronic patient records and echo images of 10 randomly selected patients from the first 3 months to assess the accuracy and appropriateness of documented diagnoses and treatment plans. Results 72 patients were seen over 11 clinics between July and December 2022. There was a low (6%) non-attendance rate, although a further 5 patients (7%) did not require an echo, due to booking errors. The most common reason for referral was suspected heart failure (33%) (table 1). Combined Heart Failure (HFrEF, HFmrEF, HFpEF) was also the most common primary diagnosis in the clinic (32%) (figure 1). There was a low rate of non-cardiac diagnoses (19%) and normal echocardiograms (33%) (figure 1). Clinic actions included prescribing (54%), cardiac monitors (24%), further imaging (15%) and blood tests (11%). The Cardiologist reviewer reported appropriate diagnosis and treatment of 10 radomly selected cases. Of 7 patients followed up in a cardiologist clinic before 10/01/2023, 5 had no significant changes in treatment or diagnosis, 1 patient had a pacemaker for asymptomatic 2nd degree AV block and another had Bisoprolol stopped due to side effects. Conclusion These preliminary results suggest the ‘scan and treat’ clinic is a viable alternative to traditional general cardiology clinic for patients who also require echocardiography. This review has a number of limitations including limited short term follow up, un-blinded cardiologist review and is not generalizable. This kind of initiative may help modernise and improve cardiology outpatient services. Further research is required to assess the efficacy of similar non-cardiologist led ‘one-stop’ clinic designs.Table 1Figure 1

Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy

BackgroundPatients with epilepsy (PWE), especially those with Generalized Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. MethodsThis was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as “not showing up for the day of an appointment without prior notice.” Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. ResultsOf the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17–3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22–3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43–0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13–0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04–0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14–0.72; p = 0.006). ConclusionsGE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.

BT12 A comparison of outcomes and cost-effectiveness in a teledermatology vs. a standard face-to-face 2-week wait UK model

Abstract Teledermatology (TD) assessment of lesions referred on the 2-week wait (2WW) pathway reduces the need for in-person review, and thus facilitates increased clinical capacity. Although studies have demonstrated that TD can be cost-effective compared with a standard face-to-face (F2F) model, there is a lack of literature on the cost-effectiveness of TD with medical photography in the UK 2WW skin cancer pathway (Snoswell C, Finnane A, Janda M et al. Cost-effectiveness of store-and-forward teledermatology. JAMA Dermatol 2016; 152:702). In this study, we undertook a retrospective analysis of a store-and-forward TD 2WW pathway supported by medical photography at a UK centre (October–November 2022). As a comparator, we looked at the outcomes of a 2WW F2F clinic that took place 1 year earlier. Primary outcomes included comparing costs associated with both TD and F2F clinics, and outcomes after initial TD vs. F2F review (discharges, surgeries and subsequent F2F reviews). Inclusion criteria for TD were age 18–60 years, &amp;lt; 3 lesions referred and lesions being on culturally nonsensitive body sites. Cost estimates were included for physicians, nurses, healthcare assistants, administration staff and medical photographers. The tariff per 2WW skin cancer referral to the trust is £159.27. In total, 292 patient images were reviewed virtually in this study. Thirty of 68 patients in the F2F group met the same age criteria as those in the TD group (18–60 years), and thus these patients were used as comparators. Each 4-h TD session comprised an assessment of 25 patients vs. 12 patients per F2F session. Discharge rates from the first clinic appointment were higher for F2F clinics than for TD clinics (76.7% vs. 58.6%). Referrals for surgery were similar between the two groups (16.7% for F2F and 17.8% for TD). However, we found there were substantially more follow-ups requested after TD assessment vs. patients reviewed in F2F clinics (23.2% vs. 6.7%). The nonattendance rate for TD was 36 of 328 patients (11.0%) vs. five of 73 (6.8%) for F2F. Per-patient cost of the TD pathway was estimated to be £16.16 vs. £25.68 for a F2F 2WW appointment. Total revenue to the trust per clinical session was estimated to be £3981.75 (TD) vs. £1911.24 (F2F). This represented additional revenue of approximately £1975 for TD. Twenty-nine of 33 TD patients who completed feedback questionnaires reported overall satisfaction with the TD pathway. In this study, outcome rates between TD and F2F groups were similar in terms of planned surgeries. Planned subsequent F2F review rates were higher for TD, and discharge rates were higher for F2F. The revenue to the trust was greater for TD than F2F.

The Man Van: Mobile targeted case finding for prostate cancer.

6522 Background: Early intervention is potentially lifesaving in prostate cancer. The debate for screening continues with recent developments suggesting the arguments in favour are becoming stronger however, barriers to access remain. The Man Van project is designed to address these with a highly novel community-based targeting of high-risk groups on a mobile unit. Methods: A bespoke mobile health vehicle was moved to 8 community-based locations in areas of high deprivation indices in London, UK, inviting men for a health check consisting of: general health questionnaires, blood pressure, height/weight, HbA1c for diabetes and a PSA test. Telemedicine was used to inform patients of outcomes. Direct referrals to secondary care was performed. Community engagement was utilised to increase uptake using: primary healthcare centres, religious organisations and community centres. Results: Between December 2021 and December 2022, 618 men were seen at our Man Van clinics at a range of community settings (non-attendance rate 24%). The highest uptake was in locations where there was collaboration with primary care to recruit patients. The median age of attendees was 56 years, range 25-87. 43% of attendees were non-white (20% black). The median BMI was 27.7, range 16.2-50.5. 422 PSA tests were performed with 14 prostate cancers (3.3%) found till date. 9 (64%) of these cancers were grade group 2 (all &gt; 5% pattern 4) or 3. Of patients diagnosed with prostate cancer the median age was 59 years, range 48-73, 10 were black (71%), median PSA 6.85 g/L, range 0.81-45, median IPSS score was 9.5, range 2-31, median IIEF-5 was 16, range 1-25. The IPSS score was significantly higher (P &lt; 0.05) in men diagnosed with prostate cancer. 1 bladder (G3pT1) and 1 oesophageal cancer (T3N2M1) were also found. 3 patients had either HGPIN or ASAP, 3 patients had renal stones, 2 urethral strictures were found. 334 HbA1c tests were performed with 18 diabetics diagnosed (5.4%). 46 patients (7.4%) required input for benign urinary symptoms and 20 for erectile dysfunction (3.2%). Primary care referrals were as follows: 171 for hypertension (27.6%), 43 for an elevated BMI (7.0%), 37 for mental health issues (6.0%), 43 for excess alcohol intake (7.0%), 51 for smoking cessation assistance (8.3%). Significantly more patients 45 years were referred for primary care follow-up versus &lt; 45 years (P &lt; 0.01). Service evaluation questionnaires showed overwhelmingly positive support for the service. Conclusions: The Man Van initiative is a novel method of linking primary and secondary care for a range of health checks, including PSA. By improving community awareness and access in high-risk groups we demonstrate high uptakes for health checks including for prostate cancer and a willingness to engage with health improvement measures. As well as comparatively high levels of prostate cancers diagnosed at early stages, high levels of other health conditions were found; improving the economic value of the service.

MP12-09 THE MAN VAN: COMMUNITY BASED TARGETED CASE FINDING FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP12-09 THE MAN VAN: COMMUNITY BASED TARGETED CASE FINDING FOR PROSTATE CANCER Masood Moghul, Fionnuala Croft, Kaljit Kaur, Netty Kinsella, Declan Cahill, and Nicholas James Masood MoghulMasood Moghul More articles by this author , Fionnuala CroftFionnuala Croft More articles by this author , Kaljit KaurKaljit Kaur More articles by this author , Netty KinsellaNetty Kinsella More articles by this author , Declan CahillDeclan Cahill More articles by this author , and Nicholas JamesNicholas James More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early intervention is potentially lifesaving in prostate cancer however barriers to early access remain. The Man Van project is designed to address these with a highly novel community-based targeting of high-risk groups on a mobile unit. METHODS: A bespoke mobile health vehicle was moved to 7 different community-based locations in areas of high deprivation indices in London, inviting men for a health check consisting of: health questionnaires, blood pressure, height/weight, HbA1c for diabetes and a PSA test where relevant. Telemedicine techniques were used to inform patients of outcomes. Direct referrals to secondary care were used if needed. Community engagement to increase uptake was performed using various methods including: primary care centres, religious organisations and community centres. RESULTS: Between December 2021 and September 2022, 444 men were seen at Man Van clinics (non-attendance rate 26%). The highest uptake was in the primary care centre. The median age of attendees was 55 years, range 25-87. 42% of attendees were non-white (30% black). The median BMI was 27.7, range 16.2-50.5. 298 PSA tests were performed with 10 prostate cancers (3.4%) found till date. 6 (60%) of these cancers were grade group 2 (all >5% pattern 4). Of patients diagnosed with prostate cancer the median age was 54 years, range 48-73, 70% were black, median PSA 5.2 μg/L, range 0.81-9.4, median IPSS score was 9.5, range 2-31, median IIEF-5 was 16, range 1-25. 1 bladder and 1 oesophageal cancer were also found. 239 HbA1c tests were performed with 14 diabetics diagnosed (5.9%). 26 patients (5.9%) required input for benign urinary symptoms and 12 for erectile dysfunction (2.7%). Primary care referrals: 98 for hypertension (22.1%), 41 for elevated BMI (9.2%), 36 for mental health issues (8.1%). Of 138 patients at risk for excess alcohol intake, 40 were referred (29%), of 62 smokers 45 were referred for smoking cessation (72.6%). Significantly more patients ≥45 years were referred for primary care follow-up versus <45 years (P<0.05). Service evaluation questionnaires showed overwhelmingly positive support for the service. CONCLUSIONS: The Man Van initiative is a novel method of linking primary and secondary care for a range of men’s health checks, including PSA. By improving community awareness and access in high-risk groups we demonstrate high uptakes for health checks including for prostate cancer and a willingness to engage with health improvement measures. Source of Funding: NHS England grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e136 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masood Moghul More articles by this author Fionnuala Croft More articles by this author Kaljit Kaur More articles by this author Netty Kinsella More articles by this author Declan Cahill More articles by this author Nicholas James More articles by this author Expand All Advertisement PDF downloadLoading ...

THE COMPLIANCE OF PSYCHIATRIC PATIENTS WITH HYPERTENSION TO MEDICATION AND FOLLOW-UP DURING THE COVID-19 PANDEMIC

IntroductionThe current SARS Covid-19 pandemic has negatively affected primary care and health system services provided to chronically ill patients, such as patients with Diabetes Mellitus, Dyslipidemia and Hypertension.ObjectivesThe recording of the number of unfulfilled scheduled visits of Psychiatric patients who are monitored in the Pathological Outpatient Clinic of Arterial Hypertension at the Psychiatric Hospital of Attica due to non-attendance, before the pandemic (9/2018 -2/2020) and during its evolution (3/2020-2 /2022).MethodsThe study was done retrospectively and included 1515 patients with a Psychiatric history and concomitant Hypertension who were examined at Outpatient Clinics during the aforementioned time intervals. The rates of missed scheduled visits, as well as discontinuation of treatment without a doctor’s indication were compared and the statistical method used was χ2 with a significance level of p&lt;0.05.ResultsThe percentage of scheduled appointments that did not take place due to patient no-shows during the pre-pandemic period was 22% (550/2500). During the pandemic the non-attendance rate increased to 36% (1132/3145). The increase in the rate of missed appointments was statistically significant with p&lt;0.001. Correspondingly, the difference in recorded discontinuation of treatment was statistically significant, 26% (523/2011) versus 33% 743/2252).ConclusionsΣτην παρούσα μελέτη διαπιστώνεται στατιστικά σημαντική αύξηση της μη προσέλευσης Ψυχιατρικών ασθενών στα Παθολογικά Εξωτερικά Ιατρεία τη περίοδο της πανδημίας. Επίσης το πρόβλημα της μη συμμόρφωσης στη συνιστώμενη αγωγή διογκώθηκε καθώς καταγράφηκε μεγαλύτερο ποσοστό μη συνιστώμενης διακοπής αγωγής για την Αρτηριακή Υπέρταση .Disclosure of InterestNone Declared

Preserving Security, Privacy of Health Passport Over Patient in Cloud

The passport is an expandable document in which key personal, social care and clinical information is recorded. Everyday people move to difference places whether abroad or within the country and some people it might happen they forgot their health passport or they are not registered in any health sectors as a result it might be difficult to have treatment without a health passport. So we designed a Cloud health passport system which is secure, fast and private which will be helpful, using block chain algorithm to allow continuous updating by family and health professionals, acting as a ‘live’ synchronized record of changing need, service. The passport is set up by the patient (or their agreed representative) and carried on their mobile device across different healthcare settings using Dynamic Searchable Symmetric Encryption (DSSE). It stores demographic details and pertinent clinical information. By having a digital record of this information, valuable patient (and administrative) time is not wasted at registration, improving the patient experience. By incorporating an individual health identifier, it allows a patient to be readily identified across any healthcare setting. The option of storing the dates of upcoming appointments could lead to a reduction in the out-patient non-attendance rate currently estimated at 15%. The increased likelihood that important clinical information is filed to the correct patient record frees up more time for direct patient care.

Impact of TeleHealth in Gastroenterology Clinic Attendance

Telehealth has become an important part of medical care during the COVID-19 pandemic. Previous studies have demonstrated patient preference for telehealth care due to convenience and time and cost savings related to travel. The increased ease of access for patients with telehealth may improve the attendance rate. Improving clinic attendance could increase clinic efficiency, decrease cost, and possibly improve patient outcomes. We intended to assess if telehealth in gastroenterology (GI) clinic improves the attendance rate. We performed a retrospective observational cross-sectional study using data from the electronic health record (EHR) of patients scheduled for an appointment at the adult gastroenterology/hepatology clinic from February 1st to May 1st, 2020. Continuous variables were compared using the independent t-test and categorical variables were compared using the chi-square test or Fisher’s exact test, where applicable. Multivariate logistic regression analysis was performed for the missed appointment using the variable visit type as the predictor of interest and patient demographics, and appointment-related factors as covariates. Of 2,258 patients scheduled for appointment, 210 (9.3%) missed their appointment. Before COVID-19 pandemic response (before March 13, 2020), all 1,133 appointments were in-person visits. During the COVID-19 era (after March 13, 2020), 806 (71.6%) appointments were televisits, conducted via telephone. In the pre-COVID era, the non-attendance rate was 7.7%; this increased to 10.9% during the COVID era (P=0.008). There was no significant difference in the non-attendance rate between televisits and in-person visits (10.7% and 8.5%; P=0.09). In the multivariate analysis, there was no significant association between visit type and attendance (adjusted odds ratio [AOR] 1.11 [0.73-1.69]). There was no significant difference in attendance before and after March 13, 2020 (AOR 1.50 [0.99-2.27]). The use of telehealth increased significantly during the COVID era. Televisit was not associated with an improved attendance rate in GI clinic. Further studies are needed to investigate the impact of telehealth in clinical practice.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

WE8.7 Are Virtual Clinics for General Surgery Here to Stay? – A Single Centre Analysis

AimVirtual clinics were rapidly established during the COVID-19 pandemic to maintain outpatient surgical care.To evaluate their use, we analysed telephone clinic outcomes and their compliance with the NHS Referral to Treatment (RTT) guidelines.MethodData was collected for patients booked into Upper GI Surgery clinics between September – December 2020 (n = 622). This included details of referral, appointments (first to most recent), patient attendance, and clinic outcomes (active monitoring, offered surgery, discharge, other). We compared first appointment management decisions between telephone and face-to-face clinics.Results317 patients had their first appointment via telephone; 179 patients were seen initially face-to-face.For first appointments, non-attendance rate was 9.8% (31/317) in telephone clinics versus 3.9% (7/181) in face-to-face clinics.At first appointment, 8.5% (27/317) of patients consulted via telephone were offered surgery compared to 20.1% (36/179) seen face-to-face.22.4% (71/317) of telephone clinic patients were started on active monitoring at first appointment, compared to 31.3% (56/179) of patients assessed face-to-face.31.3% (155/496) of all patients analysed were compliant with RTT guidelines – 57.4% initiated on active monitoring; 11.6% underwent surgery.ConclusionPatients are less likely to be listed for surgery after their first assessment if this was via telephone appointment compared to face-to-face. Delays in physical examination, and clinician and/or patient hesitancy may contribute to this; higher non-attendance rates would further postpone outcomes. However, telemedicine does allow effective active monitoring.To better evaluate telemedicine's efficacy in sustaining timely patient care, comparison of compliance with the RTT guidelines for cases managed solely face-to-face pre-COVID-19 is warranted.

Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study.

Background and AimsGastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes.MethodsThis was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments.ResultsOverall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386–4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630–2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004–1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033–1.363]; p = 0.015) as associated with appointment non-attendance.ConclusionsFemale patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.

The Effect of the 2021 Irish Cyber-Attack on Otolaryngology Outpatient Non-attendance at a Model 4 Hospital in the Post-COVID Era.

AimThis study investigates the rate of non-attendance at ENT outpatient appointments in the post-COVID era and the effect of the 2021 Irish cyber-attack on non-attendance.MethodsA retrospective review of the rates of non-attendance in a post-COVID pre-cyber-attack era wherein patients received an automated text message reminder about their appointment was compared to a post-cyber-attack era wherein the text message reminder system was disabled. In addition, these were compared with rates of non-attendance prior to when the reminder system was introduced. Three periods were compared, two weeks prior to the introduction of the text reminder system, two weeks pre-cyber-attack, and two weeks post-cyber-attack.ResultsPeriod 1 measured rates of non-attendance prior to the introduction of the text reminder system. Period 2 measured rates of non-attendance at outpatient appointments and consisted of nine clinic days, with two clinics per day. Period 3 similarly measured rates of non-attendance at outpatient appointments and consisted of 10 clinic days, with two clinics per day. The text reminder service was disabled during this collection period because of the cyber-attack. The average non-attendance rate was 16.99% for period 1, 13.00% for period 2, and 16.13% for period 3. A Fisher Exact Test was carried out on data with a p-value set at <0.05. Results reached statistical significance.ConclusionOur data shows non-attendance at ENT outpatient appointments increased without the text reminder system. Over two weeks after the attack, non-attendance increased by approximately 3%, which was statistically significant.

Introducing the 'Benign Eyelid Lesion Pathway': 1 year experience of synchronous tele-oculoplastics in a tertiary hospital.

Patients with benign eyelid lesions make up a large proportion of referrals to the oculoplastic service and lend themselves well to telemedicine with assessments heavily reliant on history, observation-based examination and photographs to enable management decision-making. Our tertiary unit set up tele-oculoplastics clinics for all new patients referred for benign eyelid lesions comprising tele-consultation with antecedent patient photograph: Benign Eyelid Lesion Pathway (BELP). One year on, we describe a retrospective analysis of 974 patients looking at distinct parameters of effectiveness. We retrospectively collected data from electronic patient records (EPR) for BELP patients from July 2020 to August 2021 (n = 974). We analysed time efficiency (referral time to treatment plan, consultation duration in minutes, average waiting times, number of patients seen per clinician and DNA rate), accessibility, safety (via video surveillance clinic) and theatre utilisation. 57.3% (n = 558) were listed for a surgical procedure direct from tele-consultation with 94.9% (n = 513) of these proceeding to surgery; 22.8% (n = 222) were discharged, 10.7% (n = 104) had further video follow-up and 6.7% (n = 65) required face-to-face follow-up. Our results showed efficient referral-to-treatment times, waiting times, consultation times and non-attendance rate. There was only a 2.57% non-attendance rate. There was no missed diagnosis of a malignancy of a presumed benign lesion. Tele-oculoplastics provides a streamlined, safe, effective, and logistically convenient way to review benign eyelid lesions. With the increased waiting times for referral to biopsy of eyelid lesions, this clinic shows it is imperative to provide digital accessibility for patient assessment and booking to operating theatre.

Service Evaluation: Patient Engagement With Online Group Psychotherapy During the COVID-19 Pandemic in West of Scotland

AimsOnline group therapy has gained popularity during the COVID-19 pandemic as an alternative to face-to-face group therapy. This service evaluation is aimed at assessing how this paradigm shift is received by the patients and how the quality of the provided services is assured and potentially improved.Methods1. We have retrospectively compared the attendance records from all psychotherapy groups in North Lanarkshire psychotherapy department between two distinct time periods: from November 2018 to January 2019 when only face-to-face groups were available (5 groups, 29 patients) and from November 2021 to January 2022 when only online groups were available (4 groups, 21 patients).2. In order to prospectively assess patient's views regarding online group therapy, Client Satisfaction Questionnaires (CSQ-4, quantitative and qualitative) were distributed to January 2022 groups only.Results1. The attendance rate was 5% lower in the face-to-face groups (76% vs 81%) while the non-attendance rate was lower by 1% in the online groups (9% vs 8%). The cancellation rate was also smaller by 5% in the online groups (14% to 9%).2. In regard to the service satisfaction rates in the online groups, 57% of patients who responded, answered that “most of their needs have been met by the online services’’, 71% answered “services helped with their problems somewhat’’, 71% answered “they think they would come back to the program again and 66% answered” they are mostly satisfied with the services received.“The predominant positive aspects of the services according to free text comments were” “communication, understanding, sense of community’’ and the negative aspects that need improvement: “return to face-to-face (71% of answers), need personal interaction’’.** We have extended the deadline for the acceptance of the responses to 20th of February 2022 due to mailing systems being slowed down by the pandemic. (7 out of 21 questionnaires have been returned)ConclusionOverall the attendance rates between the online and face-to-face group therapy exhibit minor differences. Concerning the patient satisfaction rates they reveal that the majority of patients who receive group therapy online are above-average satisfied with the services, feel that the online therapy provides a sense community but would prefer to return to face-to-face therapy.Further data and studies will be needed to reach more robust conclusions.

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

Colonoscopy is widely used for the screening, diagnosis and treatment of intestinal diseases. Adequate bowel preparation is a prerequisite for high-quality colonoscopy. However, the rate of adequate bowel preparation in outpatients is low. Several studies on supplementary education methods have been conducted to improve the rate of adequate bowel preparation in outpatients. However, the controversial results presented encourage us to perform this meta-analysis. According to the PRISMA statement (2020), the meta-analysis was registered on PROSPERO. We searched all studies up to August 28, 2021, in the three major electronic databases of PubMed, Web of Science and Cochrane Library. The primary outcome was adequate bowel preparation rate, and the secondary outcomes included bowel preparation quality score, polyp detection rate, adenoma detection rate, cecal intubation time, withdrawal time, nonattendance rate and willingness to repeat rate. If there was obvious heterogeneity, the funnel plot combined with Egger's test, meta-regression analysis, sensitivity analysis and subgroup analysis were used to detect the source of heterogeneity. RevMan 5.3 and Stata 17.0 software were used for statistical analysis. A total of 2061 records were retrieved, and 21 full texts were ultimately included in the analysis. Our meta-analysis shows that supplementary education can increase the rate of adequate bowel preparation for outpatients (79.9% vs 72.9%, RR = 1.14, 95% CI: 1.08-1.20, I2 = 87%, p<0.00001). Supplementary education shortened the withdrawal time (MD: -0.80, 95% CI: -1.54 to -0.05, p = 0.04) of outpatients, increased the Boston Bowel Preparation Scale (MD: 0.40, 95% CI: 0.36 to 0.44, p<0.00001), reduced the Ottawa Bowel Preparation Scale (MD: -1.26, 95% CI: -1.66 to -0.86, p<0.00001) and increased the willingness to repeat (91.9% vs 81.4%, RR:1.14, 95% CI: 1.04 to 1.25, p = 0.004). Supplementary education for outpatients based on the standard of care can significantly improve the quality of bowel preparation.