Does the Choice Between a Telehealth and an In-Person Appointment Change Patient Attendance?

Background: Videoconference enables outpatient appointments to be conducted in a manner that increases convenience for patients, and this increase in convenience is widely assumed to reduce failure to attend (FTA) rates. Introduction: FTA is the notation used when patients do not attend their designated outpatient appointment. FTA events waste appointment resources that could have been allocated to another patient and increase clinic waiting lists. Therefore, predicting FTA or identifying mechanisms to improve FTA rates could have both economic and patient benefits. Materials and Methods: Using activity data and patient demographic information from the immunology outpatient services at a large metropolitan hospital in Australia, descriptive statistics and regression analysis were used to investigate whether the telehealth modality or other patient or clinic characteristics had the potential to influence FTA rates. Multivariate logistic regression analysis was conducted using a panel set to group individual patient events together to explore the ability of patient characteristics or appointment characteristics to predict FTA events. Ethics approval was received from the Metro South Health Human Research Ethics Committee (HREC/18/QMS/45889). Results: From April 2016 to September 2018, 6,131 appointments occurred, with an overall FTA rate of 16%. Telehealth accounted for 254 or 4.1% of all appointments. When in-person and telehealth modalities were examined separately, the FTA rates were 16.3% and 8.7%, respectively. The greatest predictor of FTA was found to be the modality by which the clinic was delivered, in person or telehealth. Patient-specific characteristics such as Indigenous status, previous FTA behavior, and whether the person was privately funded were also important factors. Discussion and Conclusions: These results indicate that offering appropriate patients the option of telehealth has the potential to reduce FTA. Given the impact of FTA on clinic viability, caseload burden, and waiting lists, telehealth should be explored further and, where possible, should be offered as a routine alternative to in-person appointments.