UPJ INSIGHT Association of Unmet Social Needs With Missed In-Person Urology Clinic Appointments

By: Rutul D. Patel, DO, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York; So Yeon Pak, MD, Montefiore Medical Center, Bronx, New York; Max Abramson, MD, Albert Einstein College of Medicine, Bronx, New York; Kara L. Watts, MD, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York; Alexander Small, MD, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York; Nitya Abraham, MD, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York | Posted on: 17 Jul 2024

Patel RD, Pak SY, Abramson M, Watts KL, Small A, Abraham N. Association of unmet social needs with missed in-person urology clinic appointments. Urol Pract. 2024;11(4):632-638. doi:10.1097/UPJ.0000000000000571

Study Need and Importance

Social determinants of health have been linked to missed appointments in various patient populations including primary care, breast cancer, and heart failure, but analogous research in an urban urologic clinic setting is lacking. The goal of this study was to characterize the relationship between unmet social needs and urology clinic “no-show” visits within a diverse urban population and to elucidate which specific social needs were associated with higher no-show rates. We hypothesized patients with more unmet social needs would have a greater likelihood of missing their appointments, revealing a population at risk for disparities in urologic health due to potential delayed diagnosis and care.

What We Found

We retrospectively reviewed data from 5293 unique patients seen at our urology practice who also completed a social needs screener identifying areas of need. On multivariable analysis, we found that patients with 3+ unmet social needs were significantly more likely to have clinic appointment no-shows than those with 0 unmet social needs (Table).

Table. Multivariable Logistic Regression for Predictors of No-Show Status Based on Demographic Variables and Total Unmet Social Needs

	1+ vs 0 no-shows
	Odds ratio (95% CI)	P value
Continuous variables
Age (y)	1.00 (1.00-1.00)	.51
Distance to care (mi)	1.00 (1.00-1.00)	.99
Sex
Male	Reference
Female	0.87 (0.77-0.97)	.02
Race/ethnicity
Non-Hispanic White	Reference
Non-Hispanic Black	1.37 (1.07-1.75)	.01
Hispanic	1.43 (1.12-1.83)	.004
Asian	1.53 (1.09-2.18)	.02
Other	1.18 (0.83-1.69)	.36
Preferred language
English	Reference
Spanish	1.13 (0.96-1.32)	.15
Other	0.88 (0.58-1.34)	.54
Insurance payer
Private	Reference
Medicare	1.41 (1.17-1.69)	< .001
Medicaid	1.29 (1.09-1.54)	.004
Other	1.12 (0.88-1.42)	.36
Total unmet social needs
0 unmet social needs	Reference
1 unmet social need	1.16 (0.95-1.43)	.16
2 unmet social needs	1.12 (0.86-1.47)	.29
3+ unmet social needs	1.39 (1.10-1.75)	.006
Model controlled for age, distance to care, sex, race, preferred language, and insurance payer. Bolded entries indicate statistically significant difference (P < .05).

Limitations

Being a retrospective study, our analysis could not include several variables of interest, such as reason for no-show. Furthermore, we were unable to confirm whether patients ultimately received urologic care at other practices.

Interpretation for Patient Care

Unmet social needs were associated with increased no-show urology clinic visits. Routine social needs screening could identify at-risk patients who would benefit from services. This may be particularly pertinent for patients with urgent diagnoses or those requiring frequent office visits where missing appointments could impact morbidity and mortality.