Inequity in Telemedicine Use Among Patients with Cancer in the Deep South During the COVID-19 Pandemic

Abstract

Background Telemedicine use has increased significantly during the COVID-19 pandemic. It remains unclear if its rapid growth exacerbates disparities in healthcare access. We aimed to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic. Materials and Methods A retrospective cohort study was performed at the only National Cancer Institute designated-cancer center in Alabama March 2020 to December 2020. With a diverse (26.5% Black, 61% rural) population, this southeastern demographic uniquely reflects historically vulnerable populations. All non-procedural visits at the cancer center from March to December 2020 were included in this study excluding those with a department that had fewer than 100 visits during this time period. Patient and clinic level characteristics were analyzed using t-test and Chi-square to compare characteristics between visit types (in-person versus telemedicine, and video versus audio within telemedicine). Generalized estimating equations were used to identify independent factors associated with telemedicine use and type of telemedicine use. Results There were 50 519 visits and most were in-person (81.3%). Among telemedicine visits, most were phone based (58.3%). Black race and male sex predicted in-person visits. Telemedicine visits were less likely to have video among patients who were Black, older, male, publicly insured, and from lower income areas. Conclusions Telemedicine use, specifically with video, is significantly lower among historically vulnerable populations. Understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure the continued evolution of telemedicine is equitable.

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

“…In our study, females indicated lower preferences to use telehealth in the future; this is contrary to other reports that demonstrated that female cancer patients had greater satisfaction with telehealth during the COVID-19 pandemic [ 9 , 47 ]. These studies, however, did not focus on patients’ preferences for telehealth when provided with a choice between in-person and virtual visits in the future.…”

Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic

“…It is likely that these differences are the result of variable patient numbers and power to obtain statistical significance given the magnitude of odds ratios shown in Fig 3 (also S1 Appendix ). Our findings in the aggregate analysis of all oncology visits resulted in similar findings to those of Shao et al who studied a population from an NCI designated cancer center in the state of Alabama (in a population with greater minority representation than that seen in our study population) and found that patients of color were less likely to use video visits [ 29 ]. This supports the concern that telehealth might exacerbate existing inequities in healthcare and cancer care specifically if countermeasures are not developed [ 19 ].…”

“…Outside of oncology, analyses across primary and specialty practices have shown that older adults are less likely to participate in video visits [ 22 , 28 ]. A study of patients at another cancer center similarly found that older individuals were less likely to use video visits [ 29 ]. In a previous non-oncology focused analysis from our institution during a shorter time frame than that outlined in our manuscript, the mean ages for video visit users, phone visit users, and non-telehealth users were 42, 56, and 41, respectively [ 28 ].…”

“…Some have found an impact of gender on video visit completion, specifically male gender [ 29 ]. We did not see an impact of gender in our aggregate analysis of oncology visits.…”

Patients' experience and satisfaction using telemedicine for outpatient services in a Tertiary Cancer Center in Qatar during COVID‐19: A cross‐sectional study

“…A Retrospective cohort study found that lower income areas as well as adults aged 85 years or older were more likely to use phone visits over video visits, however lack of digital and cellular access proved to be a common challenge. 18 Practicality in the developing world is also questionable. A recent review of telemedicine in Sub‐Saharan Africa demonstrates clear barriers including insufficient technological infrastrucutre and medical equipment, digital illiteracy, inaccessibility to medical care and financial barriers with lack of adquate funding.…”