The Impact of Telehealth Implementation and Visit Modality on No-Show Rate in a High-Risk Obstetrics Clinic in a Safety Net Healthcare System

Introduction: Few studies have explored patient choice of visit modality between in-person, video, and telephone for prenatal care where exams are viewed as core to care and how this choice impacts no-show rate. This study evaluated the association between choice of visit modality and prenatal care visit attendance. Methods: In this observational (July 2020-June 2022) mixed methods study of an urban safety-net obstetrics clinic, we collected sociodemographic traits, telemedicine eligibility (as determined by a clinician), choice of visit modality (in-person, telephone, and video), and visit completion status. Using logistic regression analysis, we evaluated associations between sociodemographic traits, telemedicine eligibility, and visit modality with visit completion among all visits and only telemedicine-eligible visits. We interviewed patients and used thematic analysis to explore reasons for choosing a telemedicine visit and their visit experience. Results: Of 504 participants, there were 1,311 visits and 554 telemedicine-eligible visits. The no-show rate was 11.3% (148/1,311) among all visits and 14.1% (78/554) in telemedicine-eligible visits. Only phone visits were associated with higher odds of no-shows (vs. in-person visits) (adjusted odds ratio [aOR] = 2.34; 95% confidence interval [CI]: 1.10, 4.98) among all visits and telemedicine-eligible visits (aOR = 2.40; 95% CI: 1.09, 5.27). In 20 patient interviews, patients reported choosing telephone visits when the reason for the visit was perceived as less serious or if they had competing obligations. Discussion: Inconsistent with prior literature, we found higher no-show rates for phone visits, potentially because phone visits are chosen by patients who view their visit as lower priority. More research is needed to understand how telemedicine impacts disparities in prenatal care.