Transition to telemedicine and its impact on missed appointments in community-based clinics

Abstract

Background and objective The Coronavirus Aid, Relief, and Economic Security Act led to the rapid implementation of telemedicine across health care office settings. Whether this transition to telemedicine has any impact on missed appointments is yet to be determined. This study examined the relationship between telemedicine usage and missed appointments during the COVID-19 pandemic. Method This retrospective study used appointment-level data from 55 Federally Qualified Health Centre clinics in Texas between March and November 2020. To account for the nested data structure of repeated appointments within each patient, a mixed-effects multivariable logistic regression model was used to examine associations between telemedicine use and missed appointments, adjusting for patient sociodemographic characteristics, geographic classification, past medical history, and clinic characteristics. The independent variable was having a telemedicine appointment, defined as an audiovisual consultation started and finalized via a telemedicine platform. The outcome of interest was having a missed appointment (yes/no) after a scheduled and confirmed medical appointment. Results from this initial model were stratified by appointment type (in-person vs. telemedicine). Results The analytic sample included 278,171 appointments for 85,413 unique patients. The overall missed appointment rate was 18%, and 25% of all appointments were telemedicine appointments. Compared to in-person visits, telemedicine visits were less likely to result in a missed appointment (OR = 0.87, p < .001). Compared to Whites, Asians were less likely to have a missed appointment (OR = 0.82, p < .001) while African Americans, Hispanics, and American Indians were all significantly more likely to have missed appointments (OR = 1.61, p < .001; OR = 1.19, p = .01; OR = 1.22, p < .01, respectively). Those accessing mental health services (OR = 1.57 for in-person and 0.78 for telemedicine) and living in metropolitan areas (OR = 1.15 for in-person and 0.82 for telemedicine) were more likely to miss in-person appointments but less likely to miss telemedicine appointments. Patients with frequent medical visits or those living with chronic diseases were more likely to miss in-person appointments but less likely to miss telemedicine appointments. Conclusions Telemedicine is strongly associated with fewer missed appointments. Although our findings suggest a residual lag in minority populations, specific patient populations, including those with frequent prior visits or chronic conditions, those seeking mental health services, and those living in metropolitan areas were less likely to miss telemedicine appointments than in-person visits. These findings highlight how telemedicine can enable effective and accessible care by re...

Characterizing modifications to a comparative effectiveness research study: the OPTIMIZE trial—using the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME)

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The use of telemedicine in pre-surgical evaluation: a retrospective cohort study of a neurosurgical oncology practice

“…Telemedicine promotes cost effective care in the clinic setting: studies found it is strongly associated with fewer missed appointments, more equitable patient visit duration, and better physician schedule adherence [ 15 , 16 ]. Neurosurgeons have reported an increase in perceived efficiency and safety with the adoption of telemedicine in surgical neuro-oncology and even believe it could become the preferred modality of the subspecialty, perhaps in a hybrid system combining telemedicine and in-person care [ 17 , 18 ].…”

Characterizing Modifications to a Comparative Effectiveness Research Study – the OPTIMIZE Trial - Using the framework for reporting adaptations and modifications to evidence-based interventions (FRAME)

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