Having a telemedicine back-up plan in case of inclement weather could help patients keep appointments, study authors suggest. Photo: Getty Images.

With progressive eye disease, every appointment matters. But as physicians know, many patients struggle to keep appointments. Poor adherence has been linked to insurance status, severe disease, lack of formal education, low income and minority race. Anecdotally, the weather has also come up as a potential cause of patient no-shows. Researchers at Wills Eye Hospital in Philadelphia believe that weather is an often-overlooked factor affecting appointment status. In a paper published recently in Ophthalmic Epidemiology, they examined the impact of weather patterns at their clinic and found that it does indeed affect attendance.

The retrospective study followed 7,383 patients (36,810 visits) over two years. The researchers analyzed factors such as appointment date; patient’s city, state and zip code; birth date; gender; whether the patient was seen at a resident or attending clinic; and insurance type. They grouped patients by appointment status—kept, cancelled and no-show—and obtained weather data from the National Centers for Environmental Information. Travel distance was calculated using Bing Maps.

The findings showed that patients living less than 15 miles from the clinic had higher no-show rates, but lower cancellation rates compared with those who lived farther away. Patient cancellation was linked to average snowfall, storm event, new visit, follow-up appointment and travel distance >15 miles. Patient no-show was linked to resident clinic, new visit, follow-up appointment, average snowfall, storm event, windspeed and travel distance >15 miles.

Based on the data, the researchers concluded that patient age, gender, travel distance, appointment type and weather significantly impacted cancellations and no-shows. They wrote in their paper that “in conjunction with previously established interventions for decreasing patient absenteeism, physicians can consider utilizing advancements in technology and artificial intelligence to address appointment attendance.”

Some of these interventions include:

• hybrid models of telehealth using home IOP monitoring
• automatic notifications to physicians when a patient hasn’t been seen in more than six months
• automatic messages in the EHR when a patient misses an appointment

The study authors advocated in their paper for a future prospective analysis of potential interventions.