Ojinnaka Chinedum O, Johnstun Lara, Adepoju Omolola E, Nordstrom Lora, Yuh Sandra
Dept. of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
Valleywise Health, Phoenix, AZ, USA.
J Racial Ethn Health Disparities. 2025 Jan 23. doi: 10.1007/s40615-025-02289-w.
Missed clinic appointments disproportionately affect Medicaid-insured patients and residents of socioeconomically deprived neighborhoods. The role of the recent telemedicine expansion in reducing these disparities is unclear. We analyzed the relationship between census tract (CT) poverty level, residential segregation, missed appointments, and the role of telemedicine.
This retrospective cohort study used electronic health records (EHR) data merged with population datasets and restricted to adult patients (≥ 18 years) with completed or missed internal or family medicine outpatient clinic visits (03/2020-12/2022). Using generalized estimating equations, we analyzed the association between missed appointments, CT poverty level, CT residential segregation (operationalized using the isolation index), and appointment modality.
Sample size was 125,229 appointments for 68,471 unique patients (Hispanic [46.6%], White [9.4%], Black [18.7%], Asian [2.6%], Native American [1.9%], and "other race/ethnicity" [0.8%]; 18-39 years [38.2%], 40-64 years [56.4%], and > = 65 years [5.36]). There was an increased likelihood of missed appointments with increasing Hispanic isolation index (OR 1.12; 95% CI 1.03, 1.23) and decreased likelihood with increasing Black isolation index (OR 0.71; 95% CI 0.61, 0.83). The protective effect of telemedicine on missed appointments decreased with increasing Black and Hispanic isolation index.
Our results suggest that further studies are needed to understand the potential impact of telemedicine on healthcare use inequities among residents of residentially segregated areas. Targeted interventions that aim to identify and address structural factors that could limit the benefits of telemedicine use are also needed.
错过门诊预约对医疗补助保险患者以及社会经济贫困社区居民的影响尤为严重。近期远程医疗服务的扩展在减少这些差异方面所起的作用尚不清楚。我们分析了人口普查区（CT）贫困水平、居住隔离、错过预约情况以及远程医疗的作用之间的关系。
这项回顾性队列研究使用了与人口数据集合并的电子健康记录（EHR）数据，研究对象限于完成或错过内科或家庭医学门诊就诊的成年患者（≥18岁）（2020年3月至2022年12月）。我们使用广义估计方程分析了错过预约、CT贫困水平、CT居住隔离（使用隔离指数进行操作化）和预约方式之间的关联。
样本量为68471名独特患者的125229次预约（西班牙裔[46.6%]、白人[9.4%]、黑人[18.7%]、亚洲人[2.6%]、美洲原住民[1.9%]以及“其他种族/族裔”[0.8%]；18 - 39岁[38.2%]、40 - 64岁[56.4%]以及≥65岁[5.36%]）。随着西班牙裔隔离指数的增加，错过预约的可能性增加（比值比[OR]1.12；95%置信区间[CI]1.03，1.23），而随着黑人隔离指数的增加，错过预约的可能性降低（OR 0.71；95% CI 0.61，0.83）。远程医疗对错过预约的保护作用随着黑人和西班牙裔隔离指数的增加而降低。
我们的结果表明，需要进一步开展研究以了解远程医疗对居住隔离地区居民医疗服务使用不平等的潜在影响。还需要有针对性的干预措施，旨在识别和解决可能限制远程医疗使用益处的结构性因素。
