Improving patient compliance for intravitreal injections during the COVID-19 pandemic

Abstract

Purpose: Intravitreal injections (IVT) of anti-vascular endothelial growth factor are standard treatment procedures in ophthalmology for many retinal diseases. We conducted a full-cycle clinical audit to evaluate patient compliance with IVT in Penang Hospital during the COVID-19 pandemic. Study design: Full cycle audit. Methods: A 3-month audit was carried out on patients scheduled to receive IVT in the operation theatre between August and October 2019 (COVID-19 pre-pandemic period). Patient compliance rates were calculated. We set a target of 95% patient compliance rate. Interventional steps taken to improve compliance were carried out from April 2020 to September 2021 (during the Movement Control Order period). A 3-month re-audit was conducted between October and December 2021. Results: A total of 481 patients were scheduled for IVT, and 50 patients (10.4%) did not present to the appointment. The compliance rate was 89.6%. The reasons for defaulting treatment included multiple hospital visits, transportation issues, cost of transportation, loss of daily wages, and fear of COVID-19 infection. Post-intervention, a total of 895 patients were scheduled for IVT in 3 months. Among these patients, 844 patients completed their IVT appointment, while 51 patients missed the scheduled IVT. The patients’ compliance rate also rose from 89.6% to 94.3%. There was also an increase of 87.1% in the total number of scheduled IVT as compared to the pre-intervention phase. Conclusion: These interventions not only increased the number of patients receiving treatment but also improved patients’ compliance with IVT despite the COVID-19 pandemic. Patients benefited from reduced hospital visits, the cost of follow-up, and the risk of hospital infection.