Relationship Between Unmet Transportation Needs and Missed Primary Care Appointments: An Observational Study.

BACKGROUND: Missed primary care appointments are associated with worse health outcomes and increased cost of care. Social drivers of health (SDoH), such as unmet transportation needs, are linked to worse health outcomes and make it more difficult for patients to attend scheduled visits. OBJECTIVE: Analyze the association of unmet transportation needs and other SDoH with missed primary care appointments. DESIGN: This analysis was a retrospective cohort study that used Mayo Clinic electronic health records data for appointments at primary care clinics in Minnesota, Iowa, Wisconsin, Florida, and Arizona. We used logistic regression and multinomial logistic regression to evaluate the association between the exposures and missed or canceled appointments and clustered standard errors at the patient level. All results are presented as average marginal effects with 95% confidence intervals (CI). PARTICIPANTS: Adult patients with ≥ 1 primary care visit scheduled in 2023 at Mayo Clinic. MAIN MEASURES: The outcomes were missed or cancelled in-person primary care appointments and missed telemedicine primary care appointments. The main exposure was whether the patient indicated transportation barriers on the SDoH screening closest to the appointment date. Other key exposures included food insecurity, financial/utility needs, housing stability, and the HOUsing-based SocioEconomic Status (HOUSES) Index. KEY RESULTS: We identified 12,395 virtual visits and 859,346 in-person visits. Patients with transportation needs were 5.2 percentage points (95% CI, 4.4-5.9) less likely to attend a scheduled primary care visit compared to patients without transportation needs. However, transportation needs were not significantly associated with attendance at virtual visits. CONCLUSIONS: Having transportation needs was associated with missed in-person primary care appointments but not missed telemedicine appointments. Furthermore, the magnitude of the association was greater for transportation needs than other SDoH. These findings suggest transportation needs are important barriers for attending in-person primary care appointments and telemedicine may mitigate transportation barriers to accessing care.