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

IntroductionWith 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. MethodsWe 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). ResultsThere 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. DiscussionRemote 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.