Predictors of telemedicine appointment no-shows in the Peruvian social health insurance: a cross-sectional study.

Telemedicine enhances healthcare access but faces challenges with appointment no-shows. In Peru's health system, telemedicine use has expanded rapidly, yet the no-shows' determinants remain underexplored. To identify demographic, geographic, institutional, and temporal factors associated with telemedicine appointment no-shows at EsSalud's National Telemedicine Center (CENATE), we conducted a cross-sectional analysis of 538,312 scheduled telemedicine appointments representing 309,819 patients using routinely collected data from the EsSalud ExplotaDatos platform in 2023-2024 and multivariate Poisson regressions. The estimated average no-show prevalence rate was 6.4% with the highest rates in pediatric neurology and obstetrics specialties. A higher risk for no-show was observed among males, young adults (18-29 years old), residents of the Eastern macro-region, appointments at primary healthcare centers, morning shifts, end-of-year months, and end-of-workweek days. No-shows are influenced by individual, institutional, and contextual factors, highlighting the need for tailored interventions to enhance appointment adherence and optimize virtual care delivery.