“Predictors of Missed Appointments in Digestive Health: A Comparative Analysis of Telehealth and In-Person Visits”

BACKGROUND: Telehealth access is integral to digestive healthcare. This study examined demographic, insurance, and social determinants of health associated with missed telehealth appointments, with secondary comparisons to missed in-person visits. METHODS: A single-center cohort study of adult digestive health patients at the University of Virginia (2019-2024) was conducted. A total of 2,047 encounters were analyzed, including 1,356 telehealth visits (662 no-shows, 694 completed visits) and 691 in-person no-shows. Patient-level data were obtained from the electronic health record, and county-level broadband and socioeconomic data were derived from the Federal Communications Commission (FCC)'s Mapping Broadband Health in America platform. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for factors associated with nonattendance. RESULTS: Younger age (aOR 0.97 per year increase, 95% CI 0.93-0.98), Black race (aOR 1.46, 95% CI 1.02-2.19), and Hispanic/Latino ethnicity (aOR 2.32, 95% CI 1.14-6.20) were independently associated with telehealth nonattendance, whereas Medicare coverage was associated with lower odds of missed telehealth visits (aOR 0.84, 95% CI 0.26-0.88). Patients new to the tertiary care center and those presenting for an initial subspecialty visit had higher odds of telehealth nonattendance. Nonattendance varied by clinic section, with higher odds observed in Fellow's, inflammatory bowel disease, and Nutrition clinics and lower odds in Hepatology and Transplant clinics. In secondary analyses comparing telehealth and in-person no-shows, Black patients had lower odds of telehealth nonattendance relative to in-person nonattendance (aOR 0.61, 95% CI 0.44-0.84). County-level broadband access and socioeconomic measures did not differ significantly between cohorts. CONCLUSIONS: Disparities in digestive health appointment attendance persist across both telehealth and in-person care. Telehealth nonattendance was associated with patient demographic and health system factors, suggesting that telehealth expansion alone may not eliminate disparities in healthcare delivery. These findings highlight the importance of patient-level interventions and stable telehealth policies to support equitable access to digestive healthcare.