As early as mid-September 2019, the World Health Organization published a series of guidelines to help protect health workers and patients from the spread of SARS-CoV-2. All over the world, medical facilities of every complexity level, including eye clinics, have adhered to restrictive measures and made adaptations in order to ensure safe continuity of medical assistance.2–15 As shown by numerous publications in medical literature, nationwide quarantine impositions cause negative psychological effects, increasing stress among the population.16–37
The study presented herein is a questionnaire-based survey assessing direct implications of unescorted clinic visits on effective counseling and patients’ emotional status. Results are consistent with most findings cited in reports regarding psychological distress caused by the SARS-CoV-2 pandemic and spread-contention rules imposed by national governments.18–26, 28–37
Along with the physiological stress naturally embedded in a medical visit, for being examined, discussing illness and possibly undergoing a procedure, patients living the pandemic fear getting infected while commuting or staying in the clinic. Attending appointments unaccompanied adds to their sense of vulnerability, increasing their stress level.
In general, our results show that unescorted clinic appointments, as part of the restrictive measures applied by public administration during the COVID-19 pandemic, are a stress trigger for nearly one-third of patients.
Up to 40% of subjects, regardless of gender or age, feel that the absence of an escort makes it more difficult for them to understand and retain medical counseling, a fact that may have serious consequences to the actual practice, compromising therapeutic effectiveness and making the entire visit pointless. To approximately two-thirds of patients, their escorts getting a later report of the visit does not compensate for not being present during consultation, a strong indicator of the importance of a third-party presence in the completion of the visit's goal.
Considering the advantage of privacy preservation, more than half of patients are not concerned about having their medical records exposed to their escorts. When looking at the results on effective counseling, it is possible to infer that most of them prefer to share their health data in order to ensure recollection of doctor’s recommendations.
Cultural and social backgrounds play an important role in the impact of restrictive measures on patients’ welfare and effective advice. Living in the city facilitates attending clinic visits regardless of the presence of an escort. Inhabitants of big cities are usually more independent, while those living in smaller towns tend to have closer relationships with their fellows, which most certainly explains their higher stress level associated with unescorted appointments.
The nature of eye condition seems to play an important role in limiting unaccompanied trips to the doctor. Of all individuals who claim they come to the clinic less often for having no escort, half (50%) have cataract. It is possible to assume that a higher degree of dependence due to age and visual impairment makes it more difficult to adhere to a medical schedule without an escort. On the other hand, cataract rarely needs urgent intervention; therefore, patients may prefer waiting until they can be escorted at their appointments.
Despite the negative impact brought by the prohibition of escorts inside medical facilities, most patients comply with their clinical schedule. Notably, those who live with others do not miss their appointments, even if their escort must wait outside. Subgroup analysis showed that, of the 15% who limit excursions to the clinic because of being unaccompanied, over two-thirds are women and elderly, implying that age and gender are the two isolated factors significantly affecting patients’ decision to attend medical consultation in the case of having no escort.
Despite the approximately equal gender distribution in the studied sample, female higher predisposition to stress under the considered situation is clearly statistically significant. Women also show more difficulty solving their queries in the absence of an escort. Our results are in accordance with published literature on the psychological distress caused by pandemic and quarantine, showing greater impact on women,18, 20–26, 28–37 confirming the influence of gender in the emotional response to such conditions.
A few of these studies also signal age as an important factor determining pandemic stress level.19, 20, 22–26, 28–37 According to our survey, advanced age has the most overall significant impact on patients’ emotional response to the absence of an escort during medical visits. Older patients do not only experience the highest stress levels under such restriction, but also have the greatest difficulty understanding and recalling medical advice. Furthermore, they are the ones with the highest tendency to pay less visits to the clinic than they normally would, just for being unescorted.
We acknowledge as limitations of our study its relatively small sample size and the reliance on a non-validated questionnaire. However, the survey was developed to address patients’ subjective perception of unescorted clinic visits, focusing on psychological issues and potential practical consequences. The prospective design of the investigation provides a comprehensive overview of difficulties met by patients when attending eye clinics unaccompanied.
To the best of our knowledge, this is the first study assessing pandemic stress level specifically related to unescorted clinic visits and the implications of such imposition on effective medical advice. Results clearly show that older patients are the most affected by the prohibition of escorts during medical consultation, notably those above 70 years of age. Given the potential hazards to clinical practice and patients’ welfare, we propose an age-related exception to this quarantine rule, for the benefit of the elderly in that range.