Attendance at remote versus face-to-face outpatient appointments in an NHS Trust

Introduction: With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study we examined missed appointments rates, comparing remote and face-to-face appointments among different patient groups. Methods: We analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in Northwest London in 2021. Rates of missed appointments per patient were compared between remote vs. face-to-face appointments using negative binomial regression models. Models were stratified by appointment type (first or a follow-up). Results: There were 874,659 outpatient appointments for 189,882 patients, 29.5% of whom missed at least one appointment. Missed rates were 12.5% for remote first appointments and 9.2% for face-to-face first appointment. Remote and face-to-face follow-up appointments were missed at similar rates (10.4% and 10.7%, respectively). For remote and face-to-face appointments, younger patients, residents of more deprived areas, and patients of Black, Mixed, and Other ethnicities missed more appointments. Male patients missed more face-to-face appointments, particularly at younger ages, but gender differences were minimal for remote appointments. Patients with long-term conditions (LTCs) missed more first appointments, whether face-to-face or remote. In follow-up appointments, patients with LTCs missed more face-to-face appointments but fewer remote appointments. Discussion: Remote face-to-face appointments were missed more often than face-to-face first appointments, follow-ups appointments had similar attendance rates for both modalities. Sociodemographic differences in outpatient appointment attendance were largely similar between face-to-face and remote appointments, indicating no widening of inequalities in attendance due to appointment modality. ### Competing Interest Statement BH is an employee of eConsult Health Ltd, a provider of electronic consultations for NHS primary, secondary and urgent/emergency care. Other authors have no conflicts of interest to disclose. ### Funding Statement This work was funded through the Beneficial Change Network and supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London, NIHR ARC South London and NIHR North Thames. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approvals and permissions to access the Whole Systems Integrated Care datasets for the purpose of service evaluation were granted by the Northwest London Sub-Data Research Access Group on 19th August 2021 (ID-138). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets analysed during the current study are not publicly available but may be obtained from a third party. Deidentified patient data cannot be made publicly available due to information governance restrictions. Requests to access to the data sets used in this paper via a secure environment can be made via the Discover-NOW Data Access Committee: https://discover-now.co.uk/how-to-access-the-data/.