Ride-Sharing Does Not Improve Missed Appointment Rates

Krisda Chaiyachati, MD, MPH, MSHP

As the United States trends toward using more ride-sharing apps like Uber and Lyft, there has been a decline in the use of ambulances—as much as 7% down—and new data has shown that with regard to making it to primary care appointments, ride sharing is not the answer for improving attendance.

The data revealed that the missed appointment rate was only 0.2% lower for those using ride-sharing than those who did not. The research team defined a missed appointment as a no-show or same-day cancellation.

"Transportation is often a barrier to care for many patients, but solutions that don't address other barriers may not be enough to help patients get to doctor appointments,” Krisda H. Chaiyachati, MD, MPH, MSHP, the lead author, said in a statement. "While it may be a negative finding, it's an important one because it can inform future efforts to help improve attendance rates and highlights the complexity of social barriers when caring for poor patients."

The pragmatic clinical trial including 786 adult patients with Medicaid examined the rate of missed appointments for those that used ride-sharing compared to those that did not. All the patients were established patients at 1 of 2 internal medicine practices located in the same building.

Chaiyachati, the medical director of the University of Pennsylvania Medicine’s FirstCall Virtual Care, a Veterans Affairs advanced fellow, and an associate fellow at the Leonard Davis Institute of Health Economics, and the investigators allocated ride sharing for those with scheduled appointments on even-number dates (intervention arm, n = 394), and usual care for those with appointments on odd-numbered dates (control arm, n = 392).

“This study was undertaken to investigate ride share medical transportation as a viable option for reducing missed appointments that could be easily integrated. Into the menu of transportation options available to low-income patients with Medicaid,” Chaiyachati and colleagues wrote. “A negative finding is important. because it highlights that simply offering rideshare services to patients, which has been discussed within the health care industry, does not improve the attendance rate.”

The team called all patients in the intervention arm, with 288 (73.1%) answering the phone and 104 (36.1%) were interested in utilizing ride sharing. Of those interested, 11 were not offered the ride-sharing service due to a need for a wheelchair-accessible vehicle or not having a text-capable phone. In total, 93 patients (32.3%) consented to use the service and 85 (26%) utilized the service.

The overall missed appointment rate for the intervention arm was 36.5% (144 of 394) while the rate in the control arm was 36.7% (144 of 392; P = .96). When adjusting for provider type—attending physicians (28.8% intervention; 23.6% control), nurse practitioners (15.8% intervention; 10.4% control; P <.01)—there were not significant differences.

Mean cost per patient for the ride-sharing in the intervention arm was $14.00 (standard deviation, $6.88), ranging from $0 to $40.17.

Both arms received phone calls to confirm their appointment times from research assistant, 2 business days prior to their appointment. No voicemails wer left, but patients were given the ability to call back between 9am and 6pm. Each patient also received an automated call, 48 hours prior to their appointment.

Among those who answered the calls, missed appointment rate between the intervention (30.6%; 88 of 288) and control (34.8%; 94 of 270) groups were comparable (P = .28). There were no reported statistically significant differences among patient subgroups.

“Controlled clinical trials examining the effect of interventions designed to address transportation needs and, more broadly, studying interventions that address the social determinants of health with the goal of improving health care outcomes are needed and will have significant implications for future population health efforts,” Chaiyachati and colleagues concluded.

The study, “Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments,” was published in JAMA Internal Medicine.

Related Coverage >>>

Sex, Society, and Acceptance in the Black HIV Community

Why Oral Hygiene Could Help Against the Flu

Swallowing the CVS-Aetna Pill