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Telemedicine Utilization in the Ambulatory Palliative Care Setting: Are There Disparities?
Julia L Frydman1, Asem Berkalieva1, Bian Liu1
1Brookdale Department of Geriatrics and Palliative Medicine (J.L.F.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy (A.B., M.M.), Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery, New York, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (A.B., B.L., M.M.), New York, New York, USA; Department of Population Health Science and Policy (B.L.), Icahn School of Medicine at Mount Sinai, Institute for Translational Epidemiology, New York, New York, USA; Ann B. Barshinger Cancer Institute (B.M.S.), University of Pennsylvania Health System, Lancaster, Pennsylvania, USA; Division of Hematology and Oncology, Department of Medicine (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Context:
Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities.
Objectives:
To examine factors associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting.
Methods:
We collected data on patients seen in Supportive Oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics.
Results:
A total of 491 patients and 1783 visits were identified, including 1061 (60%) in-person visits and 722 (40%) telemedicine visits. Female patients were significantly more likely to utilize telemedicine than male patients (OR 1.46; 95% CI 1.11-1.90). Spanish-speaking patients (OR 0.32, 95% CI 0.17-0.61), those without insurance (OR 0.28, 95% CI 0.15-0.52), and those without an activated patient portal (Inactivated: OR 0.46, 95% CI 0.26-0.82; Pending Activation: OR 0.29, 95% CI 0.18-0.48) were less likely to utilize telemedicine.
Conclusion:
Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are male, Spanish-speaking, uninsured, or do not have an activated patient portal. In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions.
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