Missed outpatient appointments: Who's missing out and Why?

Missed outpatient appointments ("no-shows") negatively affect healthcare access, efficiency, and patient outcomes and may be particularly impactful in pediatric subspecialty care. Pediatric urology services are often centralized, requiring families to travel long distances and coordinate care around caregiver availability and competing responsibilities. Limited data directly compare predictors of missed appointments between pediatric and adult urology populations or incorporate patient- and caregiver-reported reasons for nonattendance.

We conducted an Institutional Review Board-approved retrospective review of all outpatient urology appointments scheduled at a single center between January and December 2024. This practice serves as the sole provider of pediatric urology care for a predominantly rural state. Demographic, socioeconomic, and visit-level variables were extracted from the electronic health record. Multivariable logistic regression was used to identify predictors of no-show visits in the full cohort and in pediatric and adult subgroups. Additionally, telephone interviews were conducted with pediatric caregivers and adult patients who missed appointments between March and September 2024 to assess patient- and family-reported barriers to attendance.

A total of 10,106 visits were analyzed, including 2031 pediatric visits. Pediatric patients had a higher no-show rate than adults (7% vs. 4%) and were significantly more likely to miss appointments overall (odds ratio [OR] 1.67, p < 0.001). Across all patients, governmental insurance, lack of insurance, non-English language preference, non-white race, and new patient visits were associated with increased odds of no-show. In pediatric-specific analyses, male gender, lower Childhood Opportunity Index, and follow-up visit status were significant predictors of nonattendance. Among 72 interview respondents, the most commonly reported reasons for missed visits were forgetting the appointment, transportation barriers, and competing family or childcare obligations, with caregivers of pediatric patients significantly more likely to cite family-related barriers.

Pediatric urology patients experience higher no-show rates than adults, driven by socioeconomic disadvantage, geographic barriers, and family-level responsibilities. Interventions addressing communication, transportation challenges, and structural access barriers may improve appointment adherence and access to pediatric urology care, particularly in rural settings.