- Cancer centers in the west were more than six times as likely to offer telehealth visits than other regions in the country.
- Race, older age, and income level linked to use of telehealth services at cancer centers.
- Each 10-year increase in patient age decreased the odds of a telehealth video visit by nearly 20 percent in cancer patients. Together, Black race and older age decreased the chances of a video visit by an additional 12 percent.
Newswise — CHICAGO: Two studies improve understanding of how video and telephone telehealth services are used by patients and cancer centers across the country, identifying factors that could lead to more or less use of these services and guide efforts to improve access for patients who might otherwise be shut out. Research findings were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.
To improve access to care during the COVID-19 pandemic, many medical centers shifted to telehealth services. In fact, telehealth visits increased by 50 percent during the first quarter of 2020, compared with the same period in 2019, according to the CDC. *
Telehealth appointments are more efficient than traditional face-to-face encounters, eliminating the need for long travel and wait times, plus many patients prefer the convenience of remote visits. Patients may have to overcome technical problems, internet connectivity issues and limited access to smart phones, which can make it difficult for them not use this method.
” Due to COVID, many centers had to increase telehealth services. This raises the question: “Is it possible for these centers to make that shift long-term?” Harry Doernberg is a Yale School of Medicine student.
Telehealth use among Commission on Cancer-accredited centers
For the first study, Mr. Doernberg and colleagues addressed this question by conducting a secret shopper study on 371 ACS Commission on Cancer (CoC)-accredited centers across the U.S. It was important to determine the factors that were associated with telehealth centers and those that did not. Between June and September 2020, researchers called the centers anonymously to find out if they had the capacity to offer telehealth appointments to breast cancer patients.
Among the study’s key findings:
- The vast majority of CoC-accredited centers (316 of 371) offered telehealth visits for breast cancer patients.
- After controlling for facility type (Comprehensive Community Cancer Program, Community Cancer Program, and more), teaching hospital status, and hospital size, geographic location was the only independent factor associated with telehealth access.
- Centers located in the west were over six times (OR: 6. 38) more likely to offer telehealth visits than other regions, including the northeast.
“Overall, this analysis highlights the fact that different regions of the country were more or less prepared to shift to telehealth during the pandemic,” said study coauthor Anees Chagpar, MD, MBA, MPH, FACS, FRCS (C), professor of surgery, Yale School of Medicine, and a member of Yale Cancer Center. The next question is: What’s the future? What percentage of these centers will offer telehealth services? How many patients will choose telehealth visits? How these questions play out in the future remains to be seen.”
Telehealth use among a diverse population
For the second study, Connie Shao, MD, a general surgery resident at the University of Alabama Birmingham, and her colleagues looked at telehealth use between March and December 2020 among a diverse population of patients receiving care at a Commission on Cancer-accredited National Cancer Institute-designated cancer center in Birmingham. Researchers compared socioecological factors of patients for outpatient clinic visits. This included telehealth and within-telehealth. They also compared telephone-only versus video. To identify factors that influence telehealth use, the analysis was adjusted for zip code, household income, race and sexual orientation.
Among the key findings:
- Of the 60,718 clinic visits, 84.4 percent (51,260) were in-person and 15.6 percent (9,458) were via telehealth, including video (41.7 percent) and telephone-only (58.3 percent) visits.
- Telehealth visits were primarily used by patients who were white (70.3 percent), female (63.7 percent), and had private insurance (47.5 percent). Average age was 60.
- Compared with video visits, telephone visits were used more by patients who are Black (25.8 percent vs. 18.4 percent), older (62 vs. 57), from lower income zip codes ($52,297 vs. $56,343), and publicly insured (52 percent vs. 41.4 percent).
- For each decade of advancing patient age, the likelihood of having a video visit decreased by 18 percent. This was even more pronounced in Black patients where the likelihood of a video visit dropped by 40 percent for every decade. When Black race and older age were combined, the odds of having a video visit dropped by another 12 percent. This was despite an increase in video telehealth usage during the study period.
“Telemedicine is here to stay,” Dr. Shao said. The problem is how can we ensure that patients have equal access to it? Some of our most sickest patients cannot access the telemedicine that best suits their needs. We want to offer patients, those who are far from the hospital and have a difficult time connecting with us, care with us, even as the COVID pandemic hopefully ends.”
Although telemedicine has been available for decades, COVID has accelerated its widespread use very quickly. These two studies together provide a deeper understanding of the vulnerabilities of patients who aren’t reaping the benefits of telemedicine, which will allow for more research and better access.
Currently, Dr. Shao and colleagues are implementing a process at their center where patient navigators screen patients to figure out who needs telehealth support. Patients are taught by the patient navigators how to set up video-based telemedicine visits. Patients are now able to use telehealth video visits for their current and future appointments.
” We are currently working with a group in order to expand the program, analyze its strengths and remove any stumbling blocks. Dr. Shao stated that we want to find out what could be done to make telemedicine visits more successful. “The fear of going to the hospital falls as COVID decreases.” Our concern moving forward is to find ways to better help these patients engage with us, often and remotely. A lot of these patients are rural and live hours away from a major hospital.”
Coauthors for the Yale University School of Medicine study are Walter Hsiang, BS, MBA; Victoria Marks, BS; Irene Pak; Dana Kim; Bayan Galal; Waez Umer; and Afash Haleem.
Authors have no disclosures to mention.
CITATION: Doernberg H, et al. Factors that affect Telehealth Accessibility Among Breast Centers during the Pandemic. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021. Dr. Shao’s coauthors are Marshall C. McLeod and Isabel C. dos Santos Marques (MD, PhD, FACS); Mona N. Fouad (MD, MPH); Eric Wallace, MD; Daniel I. Chu MD, FACS, and Sushanth Reddy MD, FACS.
An American College of Surgeons resident research award and an AHRQ Grant for Health Services funded the study.
CITATION: Shao C, et al. Age Exacerbates Inequity in Telemedicine Use During the Covid-19 Pandemic for Cancer Patients in the Deep South. Scientific Forum Presentation. American College of Surgeons Clinical Congress 2021.
“FACS” designates that a surgeon is a Fellow of the American College of Surgeons.
# # #
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is committed to ethical and competent surgery. Its accomplishments have had a significant impact on the American course of scientific surgery and have made it an important advocate for all patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
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