Evidence map›Paper›PMID 40664400›Full record

ArticleBMJ open2025

Impact of a community-based asynchronous review clinic on appointment attendance delays across an eye hospital network in London, UK: an interrupted time series analysis.

Siyabonga Ndwandwe, Dun Jack Fu, Joy Adesanya, Juan Carlos Bazo-Alvarez, Angus I G Ramsay, Naomi J Fulop, Josefine Magnusson, Steve Napier, Jocelyn Cammack, Helen Baker and 14 more

Abstract read
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Siyabonga NdwandweResearch Department of Primary Care and Population Health, University College London, London, UK s.ndwandwe@ucl.ac.uk.ORCID http://orcid.org/0000-0002-4449-8926
Dun Jack FuNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Joy AdesanyaMoorfields Eye Hospital NHS Foundation Trust, London, UK.
Juan Carlos Bazo-AlvarezResearch Department of Primary Care and Population Health, University College London, London, UK.ORCID http://orcid.org/0000-0002-6169-8049
Angus I G RamsayResearch Department of Behavioural Science and Health, University College London, London, UK.ORCID http://orcid.org/0000-0002-4446-6916
Naomi J FulopInstitute of Epidemiology and Health Care, University College London, London, UK.ORCID http://orcid.org/0000-0001-5306-6140
Josefine MagnussonResearch Department of Behavioural Science and Health, University College London, London, UK.
Steve NapierNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Jocelyn CammackNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Helen BakerNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Stephanie KumpunenResearch Department of Behavioural Science and Health, University College London, London, UK.
Germán Andrés Alarcón GaravitoResearch Department of Behavioural Science and Health, University College London, London, UK.
Holly ElphinstoneResearch Department of Behavioural Science and Health, University College London, London, UK.
Grant MillsUniversity College London The Bartlett School of Sustainable Construction, London, UK.
Peter ScullyUniversity College London The Bartlett School of Architecture, London, UK.
Anne SymonsUniversity College London The Bartlett School of Sustainable Construction, London, UK.
Paul WebsterUbisense Ltd, Cambridge, UK.
Jonathan WilsonMoorfields Eye Hospital NHS Foundation Trust, London, UK.
Peng Tee KhawNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Sobha SivaprasadNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Hari JayaramNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Paul J FosterNational Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.ORCID http://orcid.org/0000-0002-4755-177X
Caroline S ClarkeResearch Department of Primary Care and Population Health, University College London, London, UK.ORCID http://orcid.org/0000-0002-4676-1257
HERCULES Research Consortium

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the impact of opening a large community-based asynchronous review ophthalmic clinic on attendance delays among patients with stable chronic eye disease attending a London teaching eye hospital network.

designInterrupted time-series analysis of routine electronic health records of appointment attendances.

settingA large eye hospital network with facilities across London, UK, between June 2018 and April 2023.

participantsWe analysed 69 257 attendances from 39 357 patients, with glaucoma and medical retina accounting for 62% (n=42 982) and 38% (n=26 275) of visits, respectively. Patients over 65 made up 54% (n=37 824) of attendances, while 53% (n=37 014) were from the more deprived half of the population, and 51% (n=35 048) were males.

interventionAn asynchronous review clinic opened in a shopping centre in London, in autumn 2021, following the COVID-19 lockdown in spring 2020.

main outcome measuresAverage attendance delays (days), calculated as the difference between follow-up attendance date and the latest clinically appropriate date determined at the preceding attendance.

resultsPre-COVID-19, attendance delays for chronic eye disease monitoring were increasing by 0.9 days per week (95% CI, 0.8 to 0.9) on average, worsening to 2.0 days per week (95% CI, 2.0 to 2.0) after the first COVID-19 national lockdown, mid-March 2020. Opening the asynchronous review clinic increased appointment capacity, with delays decreasing on average by 8.1 days per week (95% CI, 8.1 to 8.2) shortly after opening. The rate of decrease slowed to 0.3 days per week (95% CI, 0.3 to 0.3) after 5 months. We found no significant differences in average attendance delays by age, gender or level of deprivation.

conclusionThe asynchronous review clinic significantly reduced attendance delays across the hospital network, addressing pre-existing backlog for stable chronic eye diseases. The reduction appeared to be maintained after the initial backlog had been cleared.

Indexed as

Appointments and SchedulesCOVID-19Eye DiseasesAdultAgedFemaleHumansInterrupted Time Series AnalysisLondonMaleMiddle AgedSARS-CoV-2Diabetic retinopathyGlaucomaHealth WorkforceOPHTHALMOLOGY

Identifiers

PMID40664400
PMCPMC12273167

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.