(Reuters Health) - Giving poor people free use of ridesharing services like Uber and Lyft for doctor appointments doesn’t make them any less likely to become no-shows than patients who have to find their own way there, a U.S. study suggests.
At one time or another, up to half of low-income patients have missed or rescheduled medical appointments because of unreliable transportation, researchers note in JAMA Internal Medicine. One solution - a transportation service for poor people insured by Medicaid - doesn’t always fix the problem because people may have to book rides days in advance, wait a long time for rides to arrive, and then carpool on long, circuitous routes to the doctor.
For the current study, researchers wanted to see if an on-demand ridesharing service like Lyft, which could take people straight from their home the doctor without any detours, might make them more likely to keep appointments. They tried giving some patients at two Penn Medicine primary care practices in Philadelphia access to free rides through Lyft while other patients had to use their usual methods of transportation.
But the free rides didn’t make a difference: 37 percent of patients missed their appointments, both in the group offered Lyft and in the control group that didn’t get this option.
“We were surprised that the effect was no different between groups,” said lead study author Dr. Krisda Chaiyachati of the University of Pennsylvania in Philadelphia.
“We think this is likely because we didn’t have a high percent of people who agreed to use the service or ultimately used it after agreeing,” Chaiyachati said by email. “We think this may be the result of the way we delivered the service or lack of familiarity.”
The study included 786 Medicaid beneficiaries who lived in West Philadelphia. People who had scheduled medical appointments on even-numbered weekdays got offered free rides through Lyft, while patients scheduled on odd-numbered days did not.
Out of 392 people eligible for free rides, only 288, or 73 percent, answered their phone when they were called with information about the service and more than half of them said they were not interested in trying it.
Just 104 people, or 36 percent, expressed interest, and only 85 people, or 29 percent, ultimately used Lyft to get to a doctor appointment.
On average, the rides people did take to the doctor cost about $14.
It’s possible that Lyft didn’t make people more likely to keep appointments because most people lived no more than 5 miles from the clinics in a region with extensive public transportation options, including buses and trolleys, the authors note.
Another limitation is that phone calls might not have been the best way to contact patients to offer the free rides, and it’s also possible that some people who did respond to phone calls might not have been comfortable with the text messaging system used to dispatch rides.
The study also didn’t assess patients’ previous experiences with ridesharing services or their perceptions about it, and it’s possible they worried about drivers refusing to come to minority or low-income neighborhoods, said Lisa Sharp, a researcher at the University of Illinois at Chicago who wasn’t involved in the study.
Patients also might have incorrectly assumed they needed a smartphone with access to the Lyft app to get a free ride, Sharp said by email. Or, transportation challenges might not have been why they missed appointments.
Still, it’s possible that ridesharing might help some patients get to the doctor more easily, particularly in low-income suburbs with fewer public transportation options, said Diana Silver, a public health researcher at New York University who wasn’t involved in the study.
“It may also take a little while to catch on, so that patients begin to know that this is available, and that it is a convenient and easy way to get to their doctors,” Silver said by email. “But other methods - like encouraging phone and email contact between providers and patients may also help patients who don’t want to come in or can’t make it in to still get questions answered and receive care.”
SOURCE: bit.ly/2EQcuo0 JAMA Internal Medicine, online February 5, 2018.
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