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

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Abstract

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.

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Funding

This work was supported by the Federation of State Medical Boards (FSMB).

Author information

Authors and Affiliations

  1. HonorHealth Internal Medicine, Phoenix, AZ, USA

    Dania A. Shah MD, Rustan Sharer MD, Dana Sall MD, MEd, Benjamin Gifford DO & Priya Radhakrishnan MD

  2. HonorHealth Clinical Informatics, Phoenix, AZ, USA

    Rustan Sharer MD, Benjamin Gifford DO & Priya Radhakrishnan MD

  3. College of Medicine, University of Arizona-Phoenix, Phoenix, AZ, USA

    Rustan Sharer MD, Dana Sall MD, MEd & Priya Radhakrishnan MD

  4. Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA

    Curt Bay PhD

  5. HonorHealth Family Medicine, Phoenix, AZ, USA

    Alethea Turner DO & Dmitry Bisk MD

  6. HonorHealth Academic Affairs, Phoenix, AZ, USA

    Wesley Peng & Priya Radhakrishnan MD

  7. Neighborhood Outreach Access to Health (NOAH) Clinic, Phoenix, AZ, USA

    Jennifer Rosas MD

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  1. Dania A. Shah MD
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Corresponding author

Correspondence to Dania A. Shah MD.

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Conflict of Interest:

Consultancies: Dr Curt Bay received a consulting fee to assist in data analysis.

Advisory Board: Dr Alethea Turner received payment for her participation on the editorial board for the Association of Family Medicine Residency Directors (AFMRD) and Family Medicine Residency Curriculum Resource as an associate editor. Drs Alethea Turner and Dmitry Bisk received payment as the members of Innovation Care partners (ICP) and Clinical Integration Committee (CIC).

Leadership/Fiduciary role: Dr Priya Radhakrishnan is the Governor of the Arizona Chapter of the American College of Physicians (ACP). She is also the Chair Elect of the ACP Board of Governors and Principal Investigator of the Improving Health Equity via Telemedicine (IHET) grant. Dr Radhakrishnan did not receive any payment.

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Dania A. Shah, MD, and Rustan Sharer, MD, are co-first authors.

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Shah, D.A., Sharer, R., Sall, D. et al. Racial, Ethnic, and Socioeconomic Differences in Primary Care No-Show Risk with Telemedicine During the COVID-19 Pandemic. J GEN INTERN MED 38, 2734–2741 (2023). https://doi.org/10.1007/s11606-023-08236-x

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