Missed Healthcare Visits during the COVID-19 Pandemic: A Longitudinal Study

Context: Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns, yet little is known about how missed visits changed over the course of the COVID-19 pandemic and patient characteristics associated with visit non-attendance during this historic time.

Objective: We sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance.

Study Design and Analysis: This study utilized data from a longitudinal cohort study (the Chicago COVID- 19 Comorbidities (C3) study). C3 participants were enrollees in one of four active, “parent” studies; they were rapidly enrolled in the C3 study at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted among this cohort to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20 - 05/19/22) were analyzed.

Setting: Multiple academic practices and community health centers in Chicago, Illinois.

Population Studied: 845 English or Spanish-speaking adults with one or more chronic conditions.

Outcome Measures: Missed visits was measured via a single item “Did you choose to miss or cancel any medical appointments because you were too worried about getting the coronavirus?”

Results: The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.14 to 22.37 (Table 2). Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves (Table 3). In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves.

Conclusion: Findings reveal that anxiety was commonly associated with missed visits during the COVID- 19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients’ emotional state during times of uncertainty.