Barriers Associated With Missed Palliative Care Telehealth Visits

Background: The COVID-19 pandemic accelerated the adoption of telehealth in palliative care. While this technology showed efficiencies in healthcare delivery, it also unmasked inequalities affecting the socially disadvantaged. Objective: To identify factors associated with missed telehealth visits. Methods: We reviewed telehealth visits between April 1, 2020 and March 31, 2021 at a palliative care clinic. Disease-related and demographic information were recorded, including residency in community outreach zones (COZ)-zip code clusters known for healthcare underutilization. We categorized patients with at least one missed visit as "any miss" (AM), and those with at least three scheduled visits and missed at least 50% as "pattern miss" (PM). Results: Of 1225 scheduled telehealth (i.e., audiovisual) visits, there were 802 completed, 52 missed initial and 371 missed follow-up encounters. Among 505 unique patients, 363 (72%) were receiving cancer treatment, 170 (34%) had multiple insurance, 87 (17%) lived in COZ, 101 (20%) were AM, and 27 (5%) were PM. Patients in COZ had significantly higher risk of PM vs those outside (OR = 2.56, 95% CI: 1.06-5.78, P = .03). Patients with multiple insurance had significantly higher risk of PM vs those with single or no coverage (OR = 3.06, 95% CI: 1.40-6.93, P = .006). Patients on treatment had significantly higher risk of AM vs those not in treatment (OR = 1.75, 95% CI: 1.05-3.06, P = .04). Conclusion: We identified living in areas with healthcare underutilization, active cancer treatment, and multiple insurance coverage as barriers to telehealth visits. Measures are necessary to attenuate disparities in accessing palliative care via telehealth.