Telehealth Versus In-Person Care: A Systematic Review of Appointment Attendance and Engagement in Vulnerable Communities.

Background

Underserved populations experience structural barriers to health care access, including transportation limitations and socioeconomic constraints, which contribute to high no-show rates. Telehealth may mitigate these barriers; however, its impact on objective health care utilization metrics requires systematic evaluation. The objective of this article is to compare visit completion and no-show rates between telehealth and in-person care among underserved populations.

Methods

A systematic search of PubMed (January 2016-January 2026) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. We included peer-reviewed studies focusing on rural, low-income, Medicaid-insured, and racial/ethnic minority populations that reported objective attendance data. This systematic review was prospectively registered in PROSPERO on February 18, 2026 (Registration No. CRD420261320752).

Results

Seventeen studies encompassing over 2.5 million encounters were included. Telehealth was consistently associated with reduced no-show rates across diverse settings. In a large safety-net system, no-show rates decreased from 25.1% to 14.6%. In primary care, telehealth narrowed the completion gap between Black and non-Black patients by 11.7 percentage points. Specialty applications, including postpartum monitoring and HIV care, demonstrated higher visit completion rates with telehealth.

Conclusions

Telehealth is associated with improved appointment adherence and reduced disparities in health care access among underserved populations. Sustaining these benefits will require continued policy support, including reimbursement for audio-only modalities.