Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.
The clinical trial, published online Feb. 5 in JAMA Internal Medicine, included 786 adults in the Philadelphia area, 72 percent of whom were women with a mean age of 46 years. Previous research showed that 24 to 51 percent of low-income patients claimed transportation as a reason for rescheduling or cancelling outpatient appointments.
Though medicaid patients are provided nonemergency medical transportation (NEMT), the research team eyed inefficiencies in this system that may have been remedied by ridesharing services.
“The design of NEMT services may be a contributor: the services require advanced scheduling (often days in advance), travel times can be long due to indirect travel routes related to picking up and dropping off other passengers, and pick-up wait times can be long,” wrote lead author Krisda H. Chaiyachati, MD, MPH, MSHP, with the Veterans Affairs Medical Center, Philadelphia. “Rideshare services provided by companies such as Uber and Lyft have been proposed as NEMT alternatives because they can be scheduled as needed, use direct routes, are readily available in most urban areas and cost less.”
Researchers conducted the trial between Oct. 24, 2016, and April 20, 2017, with patients split into control and intervention arms. Individuals in both groups were called two days before an appointment, with those in the intervention arm offered a ride via Lyft.
In the intervention group, 288 of 394 people (73.1 percent) answered the phone. Of those who did answer, 162 people (56.3 percent) were uninterested in a rideshare, 104 (36.1 percent) were interested, 93 (32.3 percent) scheduled a ride, and 85 (26 percent) used the service.
But in the end, the missed appointment rates for people who answered the phone in both groups was similar—30.6 percent (88 of 288) in the intervention arm and 34.8 percent (94 of 270) in the control arm. The study authors called for more research into the topic, even after complimentary rideshare services did not impact appointment attendance.
“Despite this trial’s lack of success, controlled clinical trials examining the effect of interventions designed to address transportation needs and, more broadly, studying interventions that address the social determinants of health with the goal of improving health outcomes are needed and will have significant implications for future population health efforts,” wrote Chaiyachati et al.