Evaluation of Telemedicine Use Among US Patients With Newly Diagnosed Cancer by Socioeconomic Status

Katz, Aaron; Haynes, Kevin; Du, Simo; Barron, John; Kubik, Rhyan; Chen, I‐Chun

doi:10.1001/jamaoncol.2021.5784

Cited by 29 publications

(35 citation statements)

References 5 publications

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“…A recent analysis of claims data from a large commercial insurer examined patients with newly diagnosed cancer at the start of the pandemic. This study showed that patients in the highest quartile of a socioeconomic index were 31% more likely to utilize telemedicine when compared with those in the lowest quartile 41 . Although telemedicine is a novel potential pathway for accessing cancer care, it is not universally accessible, and patient factors such as literacy, familiarity with technology, or access to resources such as mobile devices and wireless connections may represent barriers to telemedicine access in disadvantaged populations 42 .…”

Section: Discussionmentioning

confidence: 78%

“…This study showed that patients in the highest quartile of a socioeconomic index were 31% more likely to utilize telemedicine when compared with those in the lowest quartile. 41 Although telemedicine is a novel potential pathway for accessing cancer care, it is not universally accessible, and patient factors such as literacy, familiarity with technology, or access to resources such as mobile devices and wireless connections may represent barriers to telemedicine access in disadvantaged populations. 42 Our finding that 43% of the variation in telemedicine use patterns was driven by the physicians also emphasizes the importance of engaging providers, care teams, and health systems in understanding and directly addressing potential inequities in telemedicine access.…”

Section: Discussionmentioning

confidence: 99%

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Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Chen

et al. 2022

Cancer Medicine

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Chen

et al. 2022

Cancer Medicine

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“…A recent systematic review showed that rural cancer survivors significantly valued digital approaches to the management of their care [38]. This coupled with the ubiquity of smartphone devices and significant apprehension about the adverse consequences of disruptions or delays in cancer care may have motivated pandemic-related use of telemedicine among patients with cancer [39]. However, as others have highlighted, understanding the role of digital health strategies in the organization and delivery of rural cancer care is a significant gap in the literature [38].…”

Section: Discussionmentioning

confidence: 99%

Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study

Hassan

Chu

et al. 2022

Support Care Cancer

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Purpose Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. Methods We conducted a cross-sectional analysis of nationwide survey data assessing telemedicine use in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) in December 2020. Patients were characterized as financially distressed by self-reporting limited financial resources to manage out-of-pocket costs, psychological distress, and/or adaptive coping behaviors. Primary study outcome was telemedicine utilization during the pandemic. Secondary outcomes were telemedicine utilization volume and modality preferences. Multivariable and Poisson regression analyses were used to identify factors associated with telemedicine use. Results A convenience sample of 627 patients with cancer responded to the PAF survey. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (19-35 age compared to ≥ 75 age) (OR, 6.07; 95% CI, 1.47-25.1) and more comorbidities (≥ 3 comorbidities compared to cancer only) (OR, 1.79; 95% CI, 1.13-2.65) were factors associated with telemedicine adoption. Younger age (19-35 years) (incidence rate ratios [IRR], 1.78; 95% CI, 24-115%) and higher comorbidities (≥ 3) (IRR; 1.36; 95% CI, 20-55%) were factors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95% CI, 1.03-1.05). Conclusions The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially distressed patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.

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“…Patient level medical comorbidities were included as patients with a higher degree of comorbidities may have a differential utilization of telemedicine services. Area level measures of socioeconomic status and rurality were included, as previous studies suggest that these factors may influence telemedicine access and utilization [ 16 , 17 ]. In a secondary, exploratory analysis, limited to patients who had at least one telemedicine encounter during the study period, the primary logistic regression model was refit with at least one video telemedicine (vs. no video telemedicine) as the outcome of interest.…”

Section: Methodsmentioning

confidence: 99%

Predictors of telemedicine use during the COVID-19 pandemic in the United States–an analysis of a national electronic medical record database

et al. 2022

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Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p<0.001], non-Hispanic Black race [OR = 0.88 (95% CI 0.84, 0.93); p<0.001], and English as primary language [OR = 0.78 (95% CI 0.74, 0.83); p<0.001] were associated with a lower odds of telemedicine utilization. Female gender [OR = 1.24 (95% CI 1.22, 1.27); p<0.001], Hispanic ethnicity or non-Hispanic other race [OR = 1.40 (95% CI 1.33, 1.46);p<0.001 and 1.29 (95% CI 1.20, 1.38); p<0.001, respectively] were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends.

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Evaluation of Telemedicine Use Among US Patients With Newly Diagnosed Cancer by Socioeconomic Status

Abstract: The lowest socioeconomic status (SES) quartile is SES 1, and SES 4 is the highest quartile. Error bars represent the 95% Wilson score CIs for the proportions.

Cited by 29 publications

References 5 publications

Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study

Predictors of telemedicine use during the COVID-19 pandemic in the United States–an analysis of a national electronic medical record database

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