Some Behavioral Health Patients Were More Likely to Miss Telehealth Appointments

Many health leaders have said that telehealth can provide crucial access to behavioral health, particularly in areas with limited services.

Researchers found that behavioral health patients in Louisiana had a higher no-show rate with telehealth than those with in-person appointments. (Image credit: ©Tippapatt - stock.adobe.com)

However, a recent study shows that some behavioral health patients were more likely to miss telehealth appointments than patients who were seeing providers in the office. The results appear in a research letter on Jama Network Open published July 19.

Researchers analyzed electronic health records of patients with behavioral health needs at outpatient clinics in rural Louisiana. They examined records for more than 9,700 appointments from May 1, 2022 to Jan. 31, 2023.

The researchers found that those who had telehealth appointments missed 17% of their appointments, while those scheduled for in-person visits had a no-show rate of 13%. About two-thirds (65%) of the appointments involved telehealth.

“Comparison of no-shows between patients using telehealth and in-person care after matching indicated that patients in the telehealth cohort had statistically significantly higher odds of no-shows than patients in the in-person cohort,” the researchers wrote.

Patients who miss appointments could develop problems, while no-shows also are problematic for providers as well.

The researchers stated that they were interested in studying no-show trends among virtual and in-person appointments. They noted that there was relatively little research involving missed appointments for behavioral health in rural settings, where many patients have lower incomes.

Several factors could explain the higher rate of missed appointments for telehealth appointments, the researchers said.

It’s possible that it could be more challenging to develop a clinician-patient relationship in a virtual setting, the authors said. They said some may be missing appointments due to difficulties with the technology for telehealth appointments.

Researchers with the Northeast Delta Human Services Authority in Monroe, Louisiana and Drexel University conducted the analysis. The authors noted a key limitation to the study.

Since they concentrated on rural areas and patients with more modest incomes, they said the results may be different in other areas and among patients with higher incomes. About one in five of the patients in the study lacked stable housing, reliable internet service, and good cellular data plans, which could impede access to telehealth and lead to more missed appointments.

The authors provided suggestions to encourage behavioral health patients to stick with their telehealth appointments.

“Reducing no-shows should incorporate strategies to address unmet social needs along with programs such as sending reminders, offering flexible scheduling, and providing incentives,” the authors wrote.

Mental health professionals have touted telemedicine as a vital tool to expand access to more patients, given the shortage of behavioral health professionals. Over half of all U.S. counties are without a practicing psychiatrist, according to the University of Michigan.

Telehealth advocates also note some are leery of going in person to a doctor’s office. Some advocates note that telehealth can be appealing for those with limited transportation, parents of young children, or those with busy work schedules.

There have been encouraging signs that telehealth is effective in behavioral health. Researchers with the Centers for Disease Control and Prevention and the National Institutes of Health found patients struggling with substance abuse had a lower risk of overdose if they had a telehealth appointment.

More doctors are using telehealth, at least occasionally. Four out of five doctors (80%) used telehealth or virtual visits in 2022, according to a survey by the American Medical Association.