Financial, transportation barriers drive missed breast imaging visits

Forgotten appointments, transportation problems, and financial hardship were the most common reasons patients missed breast imaging visits at a safety-net practice, according to a study published in Academic Radiology.

The quality improvement project surveyed patients who had previously missed a breast imaging appointment and were later rescheduled. Of 260 eligible patients, 165 responded, giving the study a 63% response rate.

Lack of awareness or forgotten appointments was the most common reason, cited by 35% of respondents. Transportation issues were cited by 20%, and financial hardship by 19%.

The findings point to a broader access problem beyond simple nonattendance. Missed breast imaging visits can delay screening or diagnostic workup, reduce appointment availability for other patients, and leave imaging staff and equipment underused.

Income level was associated with differences in reasons for missed appointments, according to the study summary. That pattern suggests the barriers are not evenly distributed across patient groups and may be more acute for lower-income patients.

Patients also identified possible ways to improve attendance. Enhanced appointment reminders were the most common suggestion, cited by 29% of respondents. Funding or insurance assistance was suggested by 12%, and transportation support by 8%.

Text messaging appeared to be the preferred reminder format. Most patients selected only 1 type of reminder, and among those patients, text messaging was the most frequently selected option.

The study was conducted in a medically underserved population, which matters for how the findings should be interpreted. A reminder system alone may help some patients, but it would not address patients who cannot afford the appointment, lack insurance support, or have no reliable way to reach the imaging site.

For breast imaging practices, the data support a more practical approach to no-shows. Instead of treating missed appointments mainly as a scheduling problem, practices may need to combine reminder optimization with patient navigation, transportation resources, and clearer financial-assistance pathways.

The authors concluded that reducing missed breast imaging appointments is important for improving timely care, especially in underserved populations. They said patient-selected reminder types, along with attention to financial and transportation barriers, may improve adherence and support more equitable access to breast imaging services.