Visit no-shows (NS) reduce clinic efficiency and effective resource allocation. Inadequate follow-up among patients with chronic eye disease increases risk of disease progression. Our study identifies demographic, medical, and socioeconomic characteristics that increase odds of NS among patients with chronic eye conditions at high risk of vision-threatening complications.
This is a retrospective case–control study of data abstracted over a 5-year period (January 2013–December 2018) in an urban academic ophthalmology practice. Follow-up appointments of patients ≥ 18 years of age with a diagnosis of glaucoma, diabetic retinopathy, or age-related macular degeneration were included. Age, sex, race, ethnicity, language preference, zip code, and relevant medical history were recorded. A multivariate mixed logistic regression model was utilized to determine any association between demographic factors and visit NS.
A total of 106,652 visits for 4,598 unique patients were included in this study. Of these, 13,240 (12.4%) visits were NS. Patient characteristics that increased the odds of NS included Hispanic ethnicity (p < 0.0001), Black race (p < 0.0001), and a history of mental illness (p < 0.0001). Socioeconomic factors that increased the odds of NS included median household income < $40,000 (p = 0.002), Medicare insurance (p < 0.0001), and Medicaid insurance (p < 0.0001).
Our results highlight the influence of ethnic, racial, medical, and socioeconomic characteristics on appointment NS among patients with chronic eye disease. Future interventions aimed at reducing appointment NS could channel resources to the at-risk populations identified in this analysis to improve access to care for those who need it most.
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This publication was made possible by Grant Number 1 K23 EY030530-01 from the National Eye Institute, Yale Diabetes Center Grant P30 DK045735, and the Doris Duke Fund to Retain Clinical Scientists. This work has been supported in part by an unrestricted/challenge award to Yale Eye Center from the Research to Prevent Blindness (RPB), Inc., as well as the Yale School of Medicine Medical Student Research Fellowship.
This study was approved by Yale University’s institutional review board and was carried out in accordance with the Declaration of Helsinki and the Health Insurance Portability and Accountability Act.
Consent to Participate
Given the retrospective, chart review nature of this study the Yale University institutional review board found that informed consent could be waived for this study under federal regulation 45 CFR 46.116(d). This part of the regulations states that (1) this research involves no more than minimal risk to the subjects, (2) the waiver or alteration will not adversely affect the rights and welfare of the subjects, (3) the research could not practicably be carried out without the waiver, and (4) whenever appropriate, the subjects will be provided with additional pertinent information after participation.
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Our manuscript does not contain any individual person’s data in any form and therefore consent for publication was not obtained.
The authors declare no competing interests.
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Greig, E.C., Gonzalez-Colaso, R. & Nwanyanwu, K. Racial, Ethnic, and Socioeconomic Disparities Drive Appointment No-Show in Patients with Chronic Eye Disease. J. Racial and Ethnic Health Disparities 10, 1790–1797 (2023). https://doi.org/10.1007/s40615-022-01363-x