Background Prior work has not studied the effects of transportation accessibility and patient factors on clinic non-arrival.
Objectives Our objectives were: (1) to evaluate transportation characteristics and patient factors associated with clinic non-arrival, (2) to evaluate the comparability of bus and car drive time estimates, and (3) to evaluate the combined effects of transportation accessibility and income on scheduled appointment non-arrival.
Methods We queried electronic administrative records at an urban general pediatrics clinic. We compared patient and transportation characteristics between arrivals and non-arrivals for scheduled appointments using multivariable modeling.
Results There were 15 346 (29.8%) clinic non-arrivals. In separate car and bus multivariable models that controlled for patient and transit characteristics, we identified significant interactions between income and drive time, and clinic non-arrival. Patients in the lowest quartile of income who were also in the longest quartile of travel time by bus had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by bus (1.55; P<0.01). Similarly, patients in the lowest quartile of income who were also in the longest quartile of travel time by car had an increased OR of clinic non-arrival compared with patients in the lowest quartile of income and shortest quartile of travel time by car (1.21, respectively; P<0.01).
Conclusions Clinic non-arrival is associated with the interaction of longer travel time and lower income.
- ambulatory care
- health services research
- primary care
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Handling editor Kaveh G Shojania
Contributors All authors contributed to study design, analysis, interpretation of findings and manuscript development.
Funding The article is funded by Agency for Healthcare Research and Quality (K12HS022989) and National Institutes of Health National Heart, Lung and Blood Institute (K08HL122478).
Competing interests None declared.
Ethics approval This project was approved by the human subjects research board at the University of Pittsburgh School of Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The primary data for this study were an electronic record of scheduled paediatric clinic appointments and attendance. For the years of evaluation, with the exception of specified encounter exclusions, we analysed the entire cohort. There are no unpublished data from the study.