Amagai Saki, Vonesh Edward, Adams James, Luo Yuan
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
NPJ Digit Med. 2024 Aug 21;7(1):217. doi: 10.1038/s41746-024-01201-w.
Missed appointments, or no-shows, disrupt healthcare delivery, exacerbating chronic disease management and leading to worse health outcomes. Telehealth has surged as a viable solution to reduce no-shows and improve healthcare accessibility, especially during the COVID-19 pandemic. However, telehealth disparities and its long-term efficacy across various medical specialties remain understudied. To address this, we performed a retrospective analysis of electronic health records from a heterogenous network of hospitals in Illinois, examining telehealth use and no-shows across among 444,752 adult patients with 1,973,098 outpatient encounters across nine specialties during the sustained pandemic phase (i.e., January 1, 2021 to July 1, 2022). Among them, 84,290 (4.27%) were no-shows, and telehealth constituted 202,933 (10.3%) of the total encounters. Telehealth use during the sustained phase varied significantly by specialty type. Overall, telehealth encounters were associated with reduced no-show odds compared to in-person encounters (OR, 0.28; 95% CI, 0.26-0.29). Black and Hispanic patients, as well as those with Medicaid, had higher no-show odds relative to their counterparts, even when using telehealth. Mental health specialty had the highest telehealth usage rate and the highest no-show odds (OR, 2.99; 95% CI, 2.84-3.14) relative to other specialties included in the study. Moreover, specialty type had differential effects on no-shows for telehealth. These results underscore the variability in telehealth use by specialty type and pervasive disparities telehealth use and no-shows. As we move beyond the pandemic, our findings can inform policymakers to tailor policies and incentives to reach different patient groups as well as specialties, with varying needs, to promote equitable telehealth utilization.
失约，即未按时赴约，会扰乱医疗服务的提供，加剧慢性病管理问题，并导致更差的健康结果。远程医疗作为一种可行的解决方案迅速兴起，以减少失约情况并提高医疗服务的可及性，尤其是在新冠疫情期间。然而，远程医疗的差异及其在各个医学专科中的长期疗效仍未得到充分研究。为了解决这个问题，我们对伊利诺伊州一个异质医院网络的电子健康记录进行了回顾性分析，研究了在持续疫情阶段（即2021年1月1日至2022年7月1日）444,752名成年患者的1,973,098次门诊就诊中远程医疗的使用情况和失约情况。其中，84,290人（4.27%）失约，远程医疗占总就诊次数的202,933次（10.3%）。在持续阶段，远程医疗的使用因专科类型而异。总体而言，与面对面就诊相比，远程医疗就诊与较低的失约几率相关（比值比，0.28；95%置信区间，0.26 - 0.29）。黑人、西班牙裔患者以及医疗补助患者，即使在使用远程医疗时，其失约几率也高于相应的对照组。与研究中纳入的其他专科相比，精神科专科的远程医疗使用率最高，失约几率也最高（比值比，2.99；95%置信区间，2.84 - 3.14）。此外，专科类型对远程医疗的失约情况有不同影响。这些结果强调了远程医疗使用因专科类型而异的变异性，以及远程医疗使用和失约情况中普遍存在的差异。随着我们度过疫情，我们的研究结果可为政策制定者提供参考，以便制定政策和激励措施，针对不同需求的不同患者群体以及专科，促进公平的远程医疗利用。
