Telemedicine utilization in gynecologic cancers: understanding the digital divide

Abstract

Outpatient follow-up is important in gynecologic cancer. During COVID-19, our center implemented telemedicine (telephone and video) visits to minimize the disruption in care. Telemedicine requires access to technology and a stable internet connection. Given our center takes care of a diverse, mixed-income population, our objective was to assess if there were identifiable differences in telemedicine utilization in a diverse mixed-income population of gynecologic cancer patients treated at a single institution. We collected data on patients seen at the outpatient Gynecologic Oncology clinic at our center who underwent an inperson or telemedicine visit (telephone or video) from 3/15/2020 to 6/15/2020 as part of a quality improvement initiative. For comparison, the same data was collected in the identical period in 2019. Visit type (new/return), visit mode (in-person, telephone, and video), recorded race, and insurance type were collected from the electronic medical record. Comparisons between variables were performed using Chi-square and multivariate logistic regression. From 3/2019 to 6/2019, 679 outpatient visits occurred, all of which were in-person. In the same time period in 2020, only 388 total patient visits occurred, representing a 42.9% decrease in volume. A majority of these visits were in-person with 228 visits (58.5%), while telemedicine accounted for 161 (41.5%) of visits with 96 (24.7%) by video and 65 (16.8%) by telephone. There was no change in the overall distribution by recorded race in patients seen between 2019 and 2020 (p=0.61). The use of telemedicine (video and telephone) was not different between commercial, Medicare, and Medicaid groups (p > 0.05). African American (AA) patients had a higher proportion of Medicaid and Medicare insurance compared to non-AA groups (Medicaid: 22.5% vs. 6.1%, Medicare: 37.3% vs. 26.0%. p 0.05), however, did show that patients with Medicaid and Medicare insurance were more likely to have a telemedicine visit than an inperson visit (Medicare: aOR: 1.81 95% CI: 1.09-3.01, p<0.05, Medicaid: aOR: 5.28 95% CI: 2.03-13.72, p<0.01). Additionally, those who had a new patient visit were less likely to attend a telemedicine visit and more likely to be seen in-person (aOR 0.12, 95% CI: 0.05-0.30, p<0.01). [Display omitted] The use of telemedicine drastically increased in 2020 due to the pandemic. After adjusting for covariates, race and insurance status did not affect access to telemedicine. The disproportionate use of video visits by race should be investigated as the use of video may be influenced by eHealth literacy, access to technology, and may be linked in the future with reimbursement incentives. Given the continued integration of telemedicine in oncology care, further research into patient and system factors affecting telemedicine access should be explored. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)