Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic

• Published in: Journal of general internal medicine : JGIM 2023-09, Vol.38 (12), p.2734-2741
• Main Authors: Shah, Dania A., Sharer, Rustan, Sall, Dana, Bay, Curt, Turner, Alethea, Bisk, Dmitry, Peng, Wesley, Gifford, Benjamin, Rosas, Jennifer, Radhakrishnan, Priya
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; COVID-19 - epidemiology; Government programs; Health care; Humans; Internal Medicine; Medicine; Medicine & Public Health; Minority & ethnic groups; Original Research; Pandemics; Patients; Physicians; Population studies; Primary care; Primary Health Care; Retrospective Studies; Risk management; Risk reduction; Socioeconomic Factors; Socioeconomics; Telemedicine; United States - epidemiology
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08236-x

Background The coronavirus 2019 (COVID-19) pandemic resulted in rapid implementation of telemedicine. Little is known about the impact of telemedicine on both no-show rates and healthcare disparities on the general primary care population during the pandemic. Objective To compare no-show rates between telemedicine and office visits in the primary care setting, while controlling for the burden of COVID-19 cases, with focus on underserved populations. Design Retrospective cohort study. Setting Multi-center urban network of primary care clinics between April 2021 and December 2021. Participants A total of 311,517 completed primary care physician visits across 164,647 patients. Main Measures The primary outcome was risk ratio of no-show incidences (i.e., no-show rates) between telemedicine and office visits across demographic sub-groups including age, ethnicity, race, and payor type. Results Compared to in-office visits, the overall risk of no-showing favored telemedicine, adjusted risk ratio of 0.68 (95% CI 0.65 to 0.71), absolute risk reduction (ARR) 4.0%. This favorability was most profound in several cohorts with racial/ethnic and socioeconomic differences with risk ratios in Black/African American 0.47 (95% CI 0.41 to 0.53), ARR 9.0%; Hispanic/Latino 0.63 (95% CI 0.58 to 0.68), ARR 4.6%; Medicaid 0.58 (95% CI 0.54 to 0.62) ARR 7.3%; Self-Pay 0.64 (95% CI 0.58 to 0.70) ARR 11.3%. Limitation The analysis was limited to physician-only visits in a single setting and did not examine the reasons for visits. Conclusion As compared to office visits, patients using telemedicine have a lower risk of no-showing to primary care appointments. This is one step towards improved access to care.