Serving the most ill and vulnerable: The growth of telehealth in an oncology-embedded rural palliative care practice.

Abstract

519 Background: Many patients with cancer referred to Palliative Care (PC) have debilitating symptoms, multiple co-morbidities, and a lower functional status which may limit their ability to attend even important health care encounters. These limitations are more impactful for patients living in rural areas. Telehealth technology has become more widespread and sophisticated during and after the COVID public health emergency. Methods: Blue Ridge Cancer Care (BRCC) hired a PC physician in October of 2021 to serve its patients through symptom management, psychosocial support, and discussion of goals of care. The BRCC practice sites are located in a mountainous region of 120 mi radius, therefore for practical reasons, the PC provider evaluated patients only in 2 of the 9 sites of the practice. Between 9 and 10 months after the start of the PC practice, a survey was administered to the Oncology providers to elicit feedbacks that would help grow the program. The survey had 6 quantitative and three open text domains. Based on the results of the survey, telehealth access to PC was facilitated through changes in the indications, workflow of visits and education of staff. Results: BRCC serves about 15,000 active patients a year, with 8, 000 new consults and a total of more than 70,000 visits. Sixty percent of our patients reside in rural zip-codes. The PCS had 169 new consults 314 follow-ups and 483 total visits during the first year. One of the qualitative feedback items in the survey was “better telehealth capability for outlying clinics”. This feedback was confirmed by informal inquiries and telehealth was actively promoted for all the patients in the 9 sites of the practice. The telehealth monthly visits for PC went from an average of 3.25 during the first year to 15.16 after the implementation of the feedback from the survey. Conclusions: In our experience telehealth technology can compensate for logistic limitations to create opportunities to serve patients who are very ill and live in rural areas.