Understanding Missed Appointments: Identifying Key Factors Impeding Care in a Predominately Uninsured Hispanic Free Clinic Population

Missed outpatient appointments remain a challenge in healthcare settings, particularly in underserved communities where barriers to care are more prevalent [1]. Although barriers, including transportation and employment conflicts, are well recognized [2-4], limited data exist on the variables influencing appointment adherence at free clinics and the associations between demographic factors. This study aimed to identify patient-reported reasons for missed appointments in patients 18 years or older and potential opportunities for intervention at a free clinic that predominantly serves a Spanish-speaking, Hispanic population. A survey was conducted of patients who missed appointments at a free clinic" to protect the clinic and the patients? in Park City, Utah between January 6, 2025, and June 3, 2025. Bilingual medical assistants (English/Spanish) contacted patients by phone and administered a questionnaire capturing demographic characteristics and barriers to attendance. Responses were recorded, and qualitative responses were coded into quantitative responses for analysis. Associations between reported barriers and demographic factors were evaluated using non-parametric tests in SPSS. During the study period, 747 patients missed a total of 902 appointments. A total of 333 patients participated in the survey. The most reported barriers were school or work conflicts (n = 86, 23.1%) and forgetting appointments (n = 75, 20.1%). Forgetting (p = 0.009), miscommunication (p = 0.029), and school/work conflict (p = 0.003) were significantly associated with age. Miscommunication (p = 0.001), late to appointment (p = 0.016), and school/work conflict were significantly associated with work hours. These findings highlight employment-related constraints, memory-related barriers, and language barriers as significant contributors to missed appointments and suggest that flexible scheduling and enhanced reminder systems may improve attendance and continuity of care.