Missed appointments during COVID-19: The impact of telehealth for persons experiencing homelessness with substance use disorders

Abstract

We examined the impact of telehealth on appointment retention among individuals with substance use disorder (SUD) by housing status. We evaluated appointment status using multivariate logistic regression with primary predictor variables of visit modality, patient's housing status and interaction between these two variables. Between March 1 and September 30, 2020, there were 18,206 encounters among 1,626 clients with SUD. For telehealth encounters, the probability of an appointment no-show was significantly higher for persons experiencing homelessness compared to stably housed (37% versus 25%, p < 0.001). Housing status influences the effectiveness of telehealth as a modality of healthcare delivery for individuals with SUD.

Keywords: Persons experiencing homelessness; Substance use disorder; Telehealth.

Fig. 1

Probabilities^a of no-show encounter based on housing status (persons experiencing homelessness (PEH) vs. stably housed) and visit modality for patients with Substance Use Disorder seeking care at an outpatient behavioral health center of Denver Health, March - September 2020. Black lines on bars represent 95% Confidence Intervals of the Probabilities. ^a Probabilities are calculated as average marginal effects of visit modality on appointment status by housing status based on estimates of logistic regression model where the outcome is appointment status (no-show versus completed) and independent variables are visit modality, patient’s housing status, an interaction term of these two variables, age, sex, race/ethnicity and provider type.