The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic

• Published in: Eye (London) Vol. 26; no. 5; pp. 729 - 733
• Main Authors: Tatham, A, Murdoch, I
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-05-2012; Nature Publishing Group
• Subjects: 692/699; 692/700/1538; Appointments and Schedules; Biological and medical sciences; Chronic Disease; Clinical Study; Continuity of Patient Care - statistics & numerical data; Female; Glaucoma; Glaucoma and intraocular pressure; Glaucoma, Open-Angle - physiopathology; Humans; Intraocular Pressure - physiology; Laboratory Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Monitoring, Physiologic; Ophthalmology; Outpatient Clinics, Hospital; Patient Compliance - statistics & numerical data; Pharmaceutical Sciences/Technology; Practice Guidelines as Topic; Practice Patterns, Physicians; Retrospective Studies; Surgery; Surgical Oncology; Time Factors; clinical guidelines; outpatient; glaucoma; Glaucoma; Human; Protozoa; Eye disease; Surveillance; Glaucoma (eye); Ciliata; Ophthalmology; Monitoring; Recommendation
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2012.22

Aim
To assess the effect of appointment rescheduling on monitoring intervals and patient attendance in the glaucoma clinic.
Methods
A retrospective review of 100 consecutive patients was conducted. Patients were categorised into groups based on risk of progressive visual loss. The monitoring interval requested by the clinician was compared with the interval recommended by national guidelines. One hundred consecutive patients who had had their appointment rescheduled were also examined to assess the effect of appointment rescheduling on the actual monitoring interval. Patient non-attendance rates and attendances at the emergency department were also examined.
Results
After excluding patients with secondary glaucoma, glaucoma suspects, and those with short-term factors affecting monitoring interval, 54 patients with chronic open-angle glaucoma (COAG) were included. Forty-eight (89%) of patients had a monitoring interval requested in accordance with national guidelines (2 had longer intervals by 1–2 months and 4 had shorter time intervals). The monitoring interval was not influenced by disease severity (Kruskal–Wallis test,
P
=0.16), but was significantly shorter if the intraocular pressure was above target (
P
<0.0001) or the patient showed structural or functional progression (
P
<0.0001). Hospital-initiated appointment rescheduling led to significant lengthening of monitoring interval. The mean difference between intended and actual monitoring interval was 5.6 months. Eight percent (8/100) of patients with rescheduled appointments did not attend compared with 15% (39/265) without rescheduled appointments.
Conclusion
Clinical staff are selecting appropriate monitoring intervals for patients with COAG; however, hospital-initiated rescheduling of appointments is a major challenge to appropriate follow-up.