ArticleJournal of racial and ethnic health disparities2026
The Influence of Structural Factors and Telemedicine on Missed Appointments Among Medicaid-Insured Patients.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMissed 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.
methodsThis 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.
resultsSample 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.
conclusionOur 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.
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