Telehealth cuts no-show odds in half among trans, gender-diverse youth

Telehealth was associated with lower no-show rates for healthcare visits among transgender and gender-diverse youth in rural areas, according to research published in the April issue of The Journal of Pediatrics.

Transgender and gender-diverse youth face a myriad of physical and mental health issues, including depression and self-harm, the study noted. This minority group, particularly those living in rural America, faces trenchant barriers to accessing healthcare. While telehealth has proved effective at expanding healthcare access, it is not clear how access to this care modality affects rural transgender and gender-diverse youth.

Thus, researchers from UVA Health, the University of Virginia, and the University of Southern California aimed to examine whether telehealth affects access to gender-affirming care for rural transgender and gender-diverse youth.

The researchers conducted a retrospective analysis of EMR data from a clinic serving transgender and gender-diverse adolescents and young adults. The clinic completes approximately 10,000 visits annually and began offering telehealth visits in March 2020.

The research team used visit appointment no-show rates as the primary measure to evaluate care access. They analyzed 17,928 patient encounters for 2,908 unique individuals from March 2020 to December 2021. Of these, 4,917 (27.4 percent) were conducted via telehealth.

Though most patients (80 percent) indicated their legal sex was female, 76 percent indicated a female gender identity. Approximately 20.7 percent listed a male gender identity, and the remaining 3.2 percent were divided between transgender and those listed as ‘other’ in the EMR.

The patient provided a rural home address in 35.8 percent of the encounters. Around 5.5 percent of the visits were classified as related to gender health, 25.6 percent were for eating disorder care, and 68.9 percent were primary care visits.

Overall, the no-show rate for the 17,928 patient encounters was 10.9 percent. However, telehealth visits had a no-show rate of only 5.4 percent.

The study further shows gender health-related visits had a lower no-show rate (6.5 percent) than non-gender health visits (11.1 percent). Notably, rural patients had a lower no-show rate (8.7 percent) than non-rural patients (12.2 percent).

For gender health-related visits, rural and urban patients had similar no-show rates at 5.9 percent and 6.3 percent, respectively. However, for non-gender health encounters, rural patients had a no-show rate of 9.1 percent, while non-rural patients had a no-show rate of 12.8 percent.

In a multivariable model analysis, researchers found that the adjusted odds ratio of no-shows for telehealth visits was 0.44, which corresponds to a 56 percent reduction in the likelihood of no-shows. The adjusted odds ratio was 0.56 for gender health-related visits, which corresponds to a 44 percent reduction in odds of no-show compared with patients seeking non-gender healthcare.

“Availability of gender-affirming care is the third most-common barrier to care for individuals who are TGD [transgender and gender-diverse], which can include a lack of providers who are not only willing to provide care, but also those competent in TGD care delivery,” the researchers concluded. “Taken together with the telemedicine analysis, these results strongly suggest that offering telemedicine to TGD youth has the impact to significantly improve access to appropriate and competent care for those living in provider-shortage areas.”

The study aligns with prior research showing that telehealth supports healthcare access for transgender and gender-diverse youth.

For a study published in 2023, researchers examined the EHR data of 1,051 patients receiving care at the Seattle Children’s Gender Clinic. They gathered data for visits between April 2019 and February 2020, defined as the pre-telehealth period, and April 2020 and February 2021, the post-telehealth period.

The study shows that 52 percent of visits occurred virtually during the post-telehealth period. These virtual appointments had significantly higher completion rates (72 percent) than in-person visits (50 percent). Telehealth visits also had lower cancellation rates at 21 percent compared to 46 percent of in-person visits.