Is Telehealth Linked to Fewer No-Shows? What a Meta-Analysis and a Large Cohort Report

Missed appointments, also known as no-shows, adversely affect clinical outcomes, clinic efficiency and quality of care, according to a 2024 cohort study. The study attributes them to barriers such as work schedule conflicts and lack of transportation ^[3]. The same authors write that the widespread adoption of telemedicine following the COVID-19 pandemic has the potential to address these barriers and improve missed-appointment rates ^[3]. Two recent analyses compare non-attendance between virtual and in-person appointments, and a narrative review in headache medicine supplies context ^[1][2][3].

What the meta-analysis pooled

The broadest evidence is a 2025 systematic review and meta-analysis in BMC Health Services Research comparing no-show, or non-attendance, rates between telehealth and in-person models of care ^[1]. Its stated aim was to give clinicians and administrators a more accurate indication of what may be expected from virtual care models ^[1]. The authors searched five databases, identified 441 articles for screening and included 45 studies, all of them retrospective cohort studies ^[1].

A random effects model estimated a reduced likelihood of non-attendance among patients receiving virtual care compared with in-person groups, with an odds ratio (OR) of 0.61 ^[1]. The abstract does not report a confidence interval for this estimate ^[1].

An I2 statistic indicated a high degree of heterogeneity among the studies analysed ^[1]. A Fail-Safe N analysis suggested that the results were robust and not significantly influenced by publication bias ^[1]. The authors concluded that, on average, telehealth models of care implemented since COVID-19 provide a moderate reduction in risk of non-attendance compared with in-person alternatives ^[1]. Because every included study was a retrospective cohort, that conclusion rests on observational data ^[1].

What a single large cohort adds

The 2024 study in the American Journal of Preventive Medicine is a retrospective cohort that used electronic health record data from a safety-net academic health center with federally qualified clinics, covering March 2020 to December 2022 ^[3]. The dataset included 474,212 appointments, of which 60% were for Hispanic patients, 22.5% for non-Hispanic White patients, 13.3% for non-Hispanic Black patients, 2.7% for Asian patients, 1% for Native American patients and 0.6% for patients of other race or ethnicity ^[3].

The no-show rate was 12% for telemedicine appointments and 25% for in-person appointments ^[3]. The authors used bivariate and multivariable generalized estimating equations to analyse the relationship between no-show and appointment type, in-person versus telemedicine ^[3]. In the multivariable analysis, a telemedicine appointment was associated with a decreased likelihood of no-show compared with an in-person appointment (OR 0.40, 95% CI 0.40 to 0.41) ^[3]. The data were analysed from September to October 2023 ^[3].

Where the association was largest

Stratified adjusted regression analyses calculated the average change in the marginal effect of telemedicine appointments on no-shows across covariates ^[3]. Across race and ethnicity, that change was greatest for Native American and non-Hispanic Black patients ^[3]. The authors concluded that the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups, and the paper's title states that disparities persist ^[3]. They described strategies to increase telemedicine uptake, especially for underserved groups, as critical ^[3].

Context from a specialty review

A 2023 narrative review of telemedicine in headache medicine lists reduced no-show rates among the benefits that multiple studies have reported, alongside high satisfaction rates, improved access to headache specialists, reduced travel, quicker visits, greater cost-effectiveness and reduced wait times ^[2]. It reports that several randomized clinical trials have shown telemedicine to be non-inferior to face-to-face visits ^[2]. The main limitation it reports is the lack of a physical examination, including fundus assessment ^[2]. The authors state that the data support telemedicine for patient follow-up in particular ^[2]. As a narrative review, it serves here as background rather than as a measure of effect on attendance ^[2].

Reading the two estimates side by side

Both analyses report lower odds of non-attendance for virtual appointments than for in-person ones ^[1][3]. The single-center estimate, OR 0.40, is lower than the pooled estimate, OR 0.61 ^[1][3]. The unadjusted rates of 12% and 25% come from one health center between March 2020 and December 2022 ^[3]. The meta-analysis abstract reports the pooled odds ratio but not pooled no-show rates ^[1].

Where the scheduling setup fits

None of the three abstracts evaluates reminders, self-rescheduling or any software platform; their findings concern appointment modality ^[1][2][3]. For teams that offer virtual visits, SmartMeet combines booking pages and video meetings in one plan, with reminders by email and text, live captions, AI meeting summaries and no meeting time limit ^[SmartMeet]. It checks the host's calendar to prevent double bookings, and guests can reschedule themselves ^[SmartMeet]. A Business Associate Agreement is included, which clinics and health teams accept when they sign up, with no sales call and no extra plan; compliance also depends on how the customer uses the service ^[SmartMeet].

Limitations

• All 45 studies in the meta-analysis were retrospective cohort studies, so the pooled estimate does not come from randomized comparisons of attendance ^[1].
• The I2 statistic indicated high heterogeneity among the included studies, and the abstract gives no confidence interval for the pooled odds ratio ^[1].
• The cohort study draws on a single safety-net academic health center with federally qualified clinics during March 2020 to December 2022 ^[3].
• The finding that the association was greatest for Native American patients concerns a group that accounted for 1% of the appointments analysed ^[3].
• The headache review is narrative, gives no quantified no-show effect in its abstract, and identifies the lack of a physical examination as its main reported limitation ^[2].