Telehealth Versus In-Person Care: A Systematic Review of Appointment Attendance and Engagement in Vulnerable Communities.

BACKGROUND: Underserved populations experience structural barriers to health care access, including transportation limitations and socioeconomic constraints, which contribute to high no-show rates. Telehealth may mitigate these barriers; however, its impact on objective health care utilization metrics requires systematic evaluation. The objective of this article is to compare visit completion and no-show rates between telehealth and in-person care among underserved populations. METHODS: A systematic search of PubMed (January 2016-January 2026) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We included peer-reviewed studies focusing on rural, low-income, Medicaid-insured, and racial/ethnic minority populations that reported objective attendance data. This systematic review was prospectively registered in PROSPERO on February 18, 2026 (Registration No. CRD420261320752). RESULTS: Seventeen studies encompassing over 2.5 million encounters were included. Telehealth was consistently associated with reduced no-show rates across diverse settings. In a large safety-net system, no-show rates decreased from 25.1% to 14.6%. In primary care, telehealth narrowed the completion gap between Black and non-Black patients by 11.7 percentage points. Specialty applications, including postpartum monitoring and HIV care, demonstrated higher visit completion rates with telehealth. CONCLUSIONS: Telehealth is associated with improved appointment adherence and reduced disparities in health care access among underserved populations. Sustaining these benefits will require continued policy support, including reimbursement for audio-only modalities.