Telemedicine Reduces Missed Appointments but Disparities Persist

Abstract

IntroductionMissed appointments also known as “no-shows” adversely affect clinical outcomes, clinic efficiency, and quality of care and have been attributed to barriers such as work schedule conflicts and lack of transportation. The widespread telemedicine implementation and adoption that has occurred as a consequence of the COVID-19 pandemic has the potential to address these barriers and improve missed appointment rates. This study aims to analyze the relationship between telemedicine and missed appointments. MethodsThis retrospective cohort study used electronic health records data from a safety-net academic health center with federally qualified clinics (March 2020 to December 2022). Bivariate and multivariable generalized estimating equations were used to analyze the relationship between no-show and appointment type (in-person versus telemedicine appointment). Stratified adjusted regression analyses were used to calculate the average change in the marginal effect of telemedicine appointments on no-shows across covariates. The data was analyzed from 09/2023-10/2023. ResultsHispanic patients accounted for 60% of the 474,212 appointments, followed by non-Hispanic White (22.5%), Non-Hispanic Black (13.3%), Asian (2.7%), Native American (1%) and “other race/ethnicity” patients (0.6%). The no-show rate for telemedicine appointments was 12% compared to 25% for in-person appointments. Multivariable analysis showed that telemedicine appointment was associated with a decreased likelihood of no-show compared to in-person appointments (OR:0.40; 95% CI:0.40, 0.41). The average change in the marginal effect of telemedicine appointments on the reduction of no-shows across race/ethnicity was greatest for Native American and non-Hispanic Black patients. ConclusionsTelemedicine appointments were associated with decreased likelihood of no-shows and the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups. Strategies to increase telemedicine uptake especially for underserved groups are critical.