Missed Appointments by Hypertension Patients in Transitional Care: Race and Insurance Correlatesedit
Missed outpatient appointments represent a barrier to continuity of care. Little evidence exists on the relationship between health insurance status and missed appointments at a transitional care clinic (TCC) for underserved hypertensive patients. High blood pressure is the leading risk factor for stroke. This study examined associations between payment status and race with missed first appointments after discharge following hypertension-based hospitalization. We conducted a retrospective study using an appointment database during the first three years at a TCC that serves underserved patients. Nearly two-thirds of eligible patients (n=144) self-identified as Blacks. Three types of insurance and demographics were used to predict the missed first appointment in three two-step logistic regression models. We also examined the interaction between race and appointment status. The role of race in appointment status varied across three models. Privately insured patients had fewer missed appointments. However, the interaction analyses showed that privately insured Black patients were more likely to miss their first appointments than patients of other races or patients with other insurance types. Black patients without insurance were more likely to appear at appointments, though neither being publicly insured nor being uninsured was independently related to missed appointments. Further investigation into vulnerable populations should address mechanisms underlying these relationships.