Disparities in the use of telehealth during the COVID-19 pandemic.

Abstract

87 Background: New York City was the epicenter of the COVID-19 pandemic. Public concern about exposure and policies to “flatten the curve” led to abrupt curtailment of health care service use, including cancer. Innovative strategies to mitigate the disruption, including telemedicine, was utilized. However, this may be less accessible to minority populations. We evaluated the differences in telehealth use among minorities and non-minorities with cancer. Methods: Our health system includes an NCI designated cancer center and 8 ambulatory sites across New York City. Utilizing the electronic medical record (EMR) we collected data on all cancer patients with an in-person or telehealth visit during the peak of the pandemic from March 1, 2020 to June 1, 2020. Race/ethnicity and visit type data was collected from the EMR. Telehealth includes video visits and telephone encounters. We used ANOVA and-chi square where appropriate to identify differences between the racial and ethnic groups in terms of use and type of telehealth and compared any differences to baseline cancer center demographics. Results: There were a total of 7,681 telehealth visits during 3/1/2020-6/1/2020; 76% were video visits. At baseline in 2019, < 1% of all patient visits were conducted via telehealth. Within our cancer center our demographic breakdown for patients seen in 2019 includes 42% patients were white, 23% Black, 14% Hispanic and 7% Asian. Among those patients utilizing video visits, 50% patients were white, 17% Black, 8% Asian, and 5% Hispanic. Among those patients utilizing phone encounters, 43% patients were white, 23% Black, 7% Hispanic and 6% Asian. Conclusions: During the COVID-19 pandemic our utilization of telehealth increased exponentially. There were significant disparities observed in the use of telehealth with Black, Hispanic and Asian patients having less utilization. These findings are important as telehealth use will now become more integrated into standard oncologic care, and it is likely that we will have a second or third wave of COVID-19 infections. Future work to understand the determinants of these disparities and interventions are needed. [Table: see text]

Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story

“…Furthermore, the unavailability of technology and the lack of digital literacy could accentuate the inequalities in access to specialized medical care. And this is an issue that affects mainly the most disadvantaged population groups, such as patients of low socioeconomic status, the elderly and immigrants (82). Actually "equitable" care is one of the 6 quality dimensions of telehealth interventions provided by the Institute of Medicine's report: "care that is safe, effective, patient-centered, timely, efficient and equitable" (83).…”

Leveraging patient‐reported outcomes (PROs) in patients with pancreatic cancer: The Pancreatic Cancer Action Network (PanCAN) online patient registry experience

“…First, we found limited racial diversity among users. In an analysis of racial disparities in treatment/outcomes of over highlighted issues with racial disparities in telehealth access and use, 27 and the use of an electronic patient portal may represent a barrier for some patients to participate. Additionally, although users represented all 50 states, our review of the specific locations highlighted that most of the patients resided on the coasts, with smaller numbers from the Midwest.…”

“…26 Thus, the 2.5% representation of Black patients in the current registry likely represents their under‐representation compared to the proportion of pancreatic cancer cases in Black individuals from other datasets. The COVID19 pandemic highlighted issues with racial disparities in telehealth access and use, 27 and the use of an electronic patient portal may represent a barrier for some patients to participate. Additionally, although users represented all 50 states, our review of the specific locations highlighted that most of the patients resided on the coasts, with smaller numbers from the Midwest.…”

Lessons for Oncology From the COVID-19 Pandemic

“…Use of virtual visits rapidly increased in medical oncology, 25–29 radiation oncology, 30,31 surgical oncology, and palliative care practices 32 . Other forms of virtual care such as electronic messages from patients also substantially increased 33 .…”