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.

中文翻译：

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缺席面对面和远程医疗眼科咨询的决定因素


背景/目标 对远程医疗护理模式的评估突显了其加剧医疗保健不平等的潜力。本研究旨在识别和描述与面对面和远程医疗门诊预约缺席相关的因素。方法 2019 年 1 月 1 日至 2021 年 10 月 31 日期间在英国一家三级眼科机构进行的一项回顾性队列研究。逻辑回归对五种交付模式下所有新患者登记的缺勤情况与社会人口统计学、临床和操作暴露变量进行建模：异步疫情前同步电话、同步视听、同步面对面，疫情期间同步面对面。结果 共新登记患者85 924例（中位年龄55岁，女性54.4%）。不同交付方式的缺勤情况存在显着差异：（流行病前面对面的占 9.0%，大流行期间面对面的占 10.5%，异步占 11.7%，大流行期间同步占 7.8%）。男性、更严重的剥夺、先前取消的预约以及未自我报告的种族与所有分娩方式的缺勤密切相关。被认定为黑人的个人在同步视听诊所的出勤率较差（调整后 OR 4.24，95% CI 1.59 至 11.28），但异步视听诊所的出勤率则不然。那些没有自我报告其种族的人来自更贫困的背景，宽带接入能力更差，并且在所有模式下缺勤率均明显更高（所有 p<0.001）。结论 服务不足的人群持续缺席远程医疗预约，凸显了数字化转型在减少医疗保健不平等方面面临的挑战。 新计划的实施应同时调查弱势群体的不同健康结果。无可用数据。