Implementation of Telemedicine to Reduce No-show Rates
Author: Peter Kizza, MSC (2023)
Primary advisor: Angela Ross, DNP
Committee members: Tiffany Champagne-Langabeer, PhD, Debora Simmons, PhD
DHI Translational Project, The UTHealth Houston School of Biomedical Informatics
Missed appointments, or no-shows, are defined as “patients who neither kept nor canceled scheduled appointments” (Dayal, 2019, p.27). Missed appointments cost the United States healthcare system more than $150 billion annually. They disrupt the continuity of healthcare services, add to patients' dissatisfaction due to delays in getting new appointments, and hinder the detection and treatment of disease. The rates of missed appointments vary between countries and healthcare systems. Studies conducted previously in primary care settings found that the rate of missed appointments ranged from 5%–55% in different series in the United States. One study suggested that missed appointments are likely influenced by three kinds of barriers: personal, structural/organizational, and financial. Telemedicine can increase patients' access to care, whereas distance and travel time between patients and providers can limit it. Fortunately, telemedicine can overcome geographical barriers to healthcare, especially for specialized providers. For instance, telemedicine can be particularly beneficial for patients in medically underserved communities and rural locations with clinician shortages (Dayal, 2019). The purpose of this project is to determine whether telemedicine can help reduce no-show rates for primary care patients. In this study, methods and theories were used, and a project team was established to help create rules and guidelines for this telemedicine project. Telemedicine was implemented in three clinics, and the no-show rates were compared to three non telemedicine clinics from January to March and May to July of 2022. A questionnaire and survey were provided for staff to provide feedback about the telemedicine feature. The results showed that there was not a great disparity between no-shows for telemedicine clinics and non telemedicine clinics. The patients provided positive feedback about telemedicine, but the staff would prefer a different application than doxy.me. The return-on-investment goals were only met for one clinic. There were many limitations in the study; for instance, not all visit types were eligible for telemedicine visits. The results showed that telemedicine did not reduce no-shows in any primary care clinic in which it was tested, but it improve care access for the patients, and patients who use the feature like it.