Missed appointments have long been a significant issue in healthcare delivery, adversely affecting the quality of care, leading to treatment delays, increased emergency department visits, poorer health outcomes, and even a higher risk of death. In England, the rate of missed mental health appointments is notably high, at 19.1%. This issue affects patients and strains healthcare resources, leading to substantial financial losses. This article explores the reasons behind missed appointments, the potential of telemedicine to address these issues, and the findings of a study comparing appointment completion rates between telemedicine and in-person care.
The Causes and Consequences of Missed Appointments
Missed appointments occur for various reasons, from socioeconomic and emotional factors to logistical issues. Patients may miss appointments due to financial constraints, transportation problems, work or family commitments, or simply because they do not feel well enough to travel. Emotional factors, such as fear and avoidance, also play a role, as do negative perceptions of healthcare providers. On the system side, scheduling errors and emergencies can lead to missed appointments. The consequences of these missed appointments are severe, leading to delayed treatments, emergency visits, poorer health outcomes, and increased mortality rates.
In England, nearly one out of every five mental health appointments is missed, correlating with treatment drop-out, relapse, re-admission, and even suicide. The financial burden on the healthcare system is immense, with annual clinic-level costs reaching millions of dollars. Therefore, addressing the underlying causes of missed appointments is crucial for improving healthcare delivery and outcomes.
Telemedicine as a Solution
Telemedicine has emerged as a promising strategy to reduce missed appointments by addressing common barriers such as transportation issues, childcare responsibilities, and scheduling conflicts. By allowing patients to attend appointments remotely, telemedicine mitigates the need for travel and can be scheduled more flexibly around work and personal commitments. Furthermore, telemedicine can ensure continuity of care during environmental hazards, like extreme weather conditions, which are becoming more frequent due to climate change.
However, to optimise the use of telemedicine within healthcare delivery models, it is essential to understand its impact on appointment completion rates. Research indicates telemedicine may be particularly beneficial for patients who face significant barriers to attending in-person appointments, suggesting that telemedicine could be crucial in improving healthcare access and outcomes.
Study Findings: Telemedicine vs. In-Person Care
A retrospective cohort study conducted at the University of South Florida (USF) compared the appointment completion rates of telemedicine versus in-person care from January 2021 to April 2023. The study included a diverse patient population and analysed data from over 236,000 appointments. The results showed that telemedicine appointments had a significantly higher completion rate than in-person appointments, with telemedicine appointments being 64% more likely to be completed after adjusting for factors such as demographics, comorbidities, and travel distance.
The study found that telemedicine appointments were less likely to be cancelled or result in no-shows. Specifically, cancelled appointments occurred less frequently in the telemedicine group (21.3% vs. 29.2%), and no-show appointments were also lower (5.2% vs. 6.6%). These findings highlight the potential of telemedicine to improve appointment adherence and, consequently, healthcare outcomes.
Missed appointments pose a significant challenge to healthcare delivery, leading to adverse outcomes for patients and financial losses for healthcare systems. Telemedicine offers a viable solution by addressing many barriers preventing patients from attending in-person appointments. The study conducted at USF demonstrates that telemedicine appointments have a higher completion rate compared to in-person care, suggesting that telemedicine can play a crucial role in improving healthcare access and continuity of care.
While telemedicine shows promise, it is essential to consider patient preferences and individual barriers when implementing this modality of care. Future research should focus on understanding the experiences and outcomes of telemedicine across different clinical sub-populations and geographic settings. By integrating telemedicine into healthcare delivery models, we can enhance the quality of care, reduce missed appointments, and mitigate the adverse effects of delayed or missed healthcare services.
Source Credit: JAMIA OPEN
Image Credit: iStock
