Patient Portal Access and Missed Medical Appointments: A Case-Control Study

Missed appointments (no-shows) in primary care compromise timely access to care and contribute to higher healthcare costs. The expansion of patient portals, mandated by the 21st Century Cures Act, and the broader adoption of digital tools may transform how patients engage with their healthcare providers. We conducted a case-control study using electronic medical records from an academic family medicine clinic between April and May 2023. Eligible participants were patients 18 years and older. Cases were the no-shows. Two controls, patients who attended their appointments, were randomly selected for each case. Logistic regression was used to examine the association between patient portal access and no-shows, adjusting for sociodemographic and clinical covariates. Patients who missed appointments were less likely to have access to the patient portal (odds ratio: 0.43; 95% confidence interval: 0.30-0.59). Factors positively associated with no-shows included being non-Hispanic Black, Hispanic, and having public insurance or no insurance. Hypertension and osteoarthritis were negatively associated with no-shows. Access to patient portals was associated with lower odds of missed appointments, suggesting that digital engagement tools may improve adherence to primary care visits.