Characteristics of patients dismissed from a retina practice

To evaluate the demographic, clinical, and behavioural characteristics associated with patient dismissals in a retina-only private practice.

A Retrospective cohort study was conducted of all patients seen at a single-specialty retina practice over a seven-year period (N = 174,250), including 432 patients who were formally dismissed. Dismissed patients were compared to retained patients across demographic, clinical, and behavioural characteristics. Data on reasons for dismissal, diagnoses, and treatment history were collected and analysed.

Among 174,250 patients seen during the study period, 432 (0.25%) were dismissed. The most common reasons included noncompliance with medical recommendations (n = 260, 60.2%) and aggressive or inappropriate behaviour (n = 79, 18.2%). Compared to retained patients, dismissed patients were younger (mean of 55.9 vs. 66.3 years, p < 0.001), had lower average adjusted gross income based on zip code analysis ($93,124 vs. $109,431, p < 0.001), and higher social deprivation index (43.4 vs. 35.1, p < 0.001). Diabetic retinopathy was significantly more prevalent among dismissed patients (26.9% vs. 9.9%, p < 0.001). Multivariable analysis identified younger age and higher social deprivation index as independent predictors of dismissal due to violent behaviour (p < 0.05).

While patient dismissals were infrequent, they disproportionately affected younger, socioeconomically disadvantaged patients and those with conditions requiring intensive management, such as diabetic retinopathy. Given the potential impact on patient care and outcomes, strategies aimed at improving compliance and addressing socioeconomic barriers may reduce dismissals and improve continuity of care.