Video Visits Research Articles

Accuracy Assessment of Outpatient Telemedicine Encounters at an Academic Ophthalmology Department

Abstract Purpose We assess the clinical accuracy of direct-to-patient real-time outpatient video visit encounters at our eye center. Design This was a retrospective longitudinal study. Subjects and Methods Patients who completed a video visit over a 3-week period between March and April 2020 were included. Accuracy assessment was determined by comparing diagnosis and management from the video visit with subsequent in-person follow-up over the next year. Results A total of 210 patients (mean age 55±18 years) were included, of whom 172 (82%) were recommended a scheduled in-person follow-up encounter after their video visit. Among the 141 total patients who completed in-person follow-up, 137 (97%) had a diagnostic agreement between telemedicine and in-person evaluation. Management plan agreed for 116 (82%), with the remainder of visits either escalating or deescalating treatment upon in-person follow-up with little substantive change. Compared with established patients, new patients had higher diagnostic disagreement following video visits (12 vs. 1%, p=0.014). Acute visits trended toward more diagnostic disagreement compared with routine visits (6 vs. 1%, p=0.28) but had a similar rate of management change on follow-up (21 vs. 16%, p=0.48). New patients were more likely to have early unplanned follow-up than established patients (17 vs. 5%, p=0.029), and acute video visits were associated with unplanned early in-person assessments compared with routine video visits (13 vs. 3%, p=0.027). There were no serious adverse events associated with the use of our telemedicine program in the outpatient setting. Conclusions Video visits had high diagnostic and management agreement with subsequent in-person follow-up encounters.

Surgeon Personal Factors Associated with Care Strategies in Musculoskeletal Telehealth.

Most surgeons used, or are currently using telehealth during the SARS-CoV-2 (COVID-19) pandemic. We studied surgeon personal factors associated with relative use of telehealth during the worldwide height of the pandemic. Questions/Purposes: (1) Are there any personal factors/characteristics associated with use and utilization of telehealth? (2) What are surgeon's perspectives/ opinions with regard to use of telehealth for five common upper extremity conditions in terms of future prospects and viability? Hand and upper extremity surgeons in the Science of Variation Group (SOVG) were invited to participate in a web-based survey. The first part of the survey focused on surgeon characteristics and work preferences. The second part focused on care strategies during the pandemic and utilization of telehealth. The final part of the survey addressed the care of five common upper extremity conditions during the pandemic. Ninety percent of surgeons used telehealth during the first few months of the pandemic, but only 20% of visits were virtual. A greater percentage of telehealth visits compared to office visits was independently associated with a policy of only seeing people with emergencies in person (RC: 0.64; CI 95%: 0.21 to 1.1; P<0.01). Surgeons found it difficult to reproduce most parts of the physical examination on video, but relatively easy to make a diagnosis, with both ratings associated with less belief that the physical exam is essential. Comfort in offering surgery by video visit was associated with having young children, preference for remote meetings, and less belief that the physical exam is essential. Utilization of, and comfort with, telehealth is related to personal factors and preferences, acceptance of a more limited physical examination in particular. Utilization of early adopters and training to increase comfort with the probabilistic aspects of medicine could facilitate incorporation of telehealth into standard practice.

Poster 236: There is No Difference in Early Functional Outcomes for Patients Undergoing Tele-Rehabilitation versus Standard in Office Rehab after Arthroscopic Meniscectomy: A Randomized Controlled Trial

Objectives:While a growing body of evidence has demonstrated that tele-rehabilitation is effective, the functional outcomes of patients undergoing tele-rehabilitation as compared to in-person rehabilitation after arthroscopic meniscectomy remains unclear. This is especially salient against the backdrop of COVID-19 and the Delta variant and the subsequent increased demand for remote care of these patients.Methods:A randomized-controlled trial was conducted including patients scheduled to undergo arthroscopic meniscectomy for meniscal injury by one of five fellowship trained sports medicine surgeons between August 2020 and May 2021. Patients were randomized to receive tele-rehabilitation, defined as exercises and stretches provided by trained physical therapists over a synchronous face-to-face video visit, or in-person rehabilitation for their post-operative course. International Knee Documentation Committee Subjective Knee Form (IKDC) score and Visual Analogue Scale (VAS) score were collected at timepoints of baseline, 3 months, 6 months, and 12 months post-operatively. Statistical analysis was conducted using Student T-test to assess for differences across the two groups.Results:An interim analysis was conducted on 60 patients with 6 month follow-up outcomes. There were no significant differences in VAS scores between groups at baseline (p =0.716) and 3 months postoperatively (p = 0.700). and 6 months postoperatively (p = 0.688). In addition, no significant differences in IKDC scores were seen between the groups at baseline (p = 0.146) and 3 months (p = 0.746). At 6 months, 24 patients were available with no significant differences observed across groups at this time point (IKDC; p = 0.633) (VAS; p = 0.688).Conclusions:Tele-rehabilitation is demonstrated to be as efficacious as traditional in-person rehabilitation following arthroscopic meniscectomy at up to 6 months post-op. This serves as a convenient and safe alternative for conventional patients during their post-operative course.

Meeting the Challenges of COVID-19: Evaluation of Nurse-Led Changes to Telephonic Assessment.

The early months of the COVID-19 pandemic caused suspension of physician home visits at our NYC home-based primary care practice as well as disruptions in community-based services homebound patients rely on. This produced gaps in care for a vulnerable patient population that is considered underserved and medically and socially complex. Telephone triage nurses at Mount Sinai Visiting Doctors Program responded to these gaps in care with targeted enhancements to telephonic patient assessment: creating an encrypted email address to receive photographs, the use of two Epic dot phrases to screen and educate regarding COVID-19, assessment of patients' ability to complete a video visit, the reassessment of goals of care, and the assessment of changes in home care services. We surveyed 15 attending physicians in our practice to evaluate primary care providers' opinions regarding changes in nurse telephone triage and how helpful they were in managing patients at home during the early pandemic. We found enhancements to nurse telephone triage were viewed by physicians as beneficial, valuable, and improved patient care. Physicians found changes improved timeliness of care, could improve self-management, helped avoid transfer to emergency department, and helped manage patient care at home. As the pandemic continues and telehealth becomes more widely used, nurse telephone triage may be adaptable to help care for a variety of patient populations during future public health emergencies.

Factors to Consider for Successful Telemedicine Gastroenterology Subspecialty Visits in Disparate Populations

Introduction: Telemedicine was put at the forefront of the healthcare delivery process during the coronavirus disease 2019 (COVID-19) pandemic. Pre-COVID-19 research had shown telemedicine to be beneficial in the gastroenterology field with improved quality of life and reduced healthcare cost in the IBD population. However, telemedicine remained underutilized in subspecialty care with constraints at both provider and patient level. Objective: To analyze the telemedicine encounters in a gastroenterology clinic at a tertiary care hospital and identify factors that facilitate or limit the use of telemedicine modalities. Methods: The project was a retrospective, single-center study with continuous sampling of one hundred and fifty-three patients who scheduled one hundred and fifty-eight telemedicine encounters that included both Inflammatory Bowel Disease (IBD) and general gastroenterology patients. We examined the influence of age, sex, race, geographic location and payer source, on audio or video telemedicine encounters, as well as the show rate. Results: Our study showed a promising show rate of 90.5% with a majority of the patients preferring video over audio visits; however, increasing age proved to be a barrier in successfully completing video visits. In total, 26.2% of the patients who desired video encounters had to be switched to audio only. We found that race, sex, payor source, and living in a rural zip code did not influence the rate of completed telemedicine encounters or the patients’ preferred modality (audio vs video). Conclusion: The recurring COVID-19 surge due to different variants provides an opportunity to refine the telemedicine experience in our healthcare. Telemedicine encounters have a promising role in gastroenterology outpatient care and can be utilized to improve access to care and bridge healthcare disparities. In order to increase compliance further work needs to be done to make the digital platform user friendly for the elderly population.

The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures

OBJECTIVETo understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic. METHODSWe retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. Median days between video and in-person visits were compared between concordant and discordant cases using the Mann-Whitney U test; P < .05 was significant. RESULTSOverall, 195 (33%) were evaluated by new patient video visits and had a procedure scheduled, of which, 186 (95%) had concordant plans after in-person evaluation. Further, 99% of plans for in-office procedures and 91% for operating room procedures were unchanged. Four patients (2.1%) had surgical plans altered after changes in clinical course, two (1%) due to additional imaging, and three (1.5%) based on genitourinary examination findings. Days between video visit and in-person evaluation did not differ significantly in concordant cases (median 37.5 [IQR, 16 - 80.5]) as compared to discordant cases (median 58.0 [IQR, 20 - 224]; P = .12). CONCLUSIONSMost surgical plans developed during new patient video visits remain unchanged after in-person examination. However, changes in clinical course or updated imaging can alter operative plans. Likewise, certain urologic conditions (eg, penile cancer) rely on the genitourinary examination to dictate surgical approach.

Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID-19 pandemic: A pilot programme.

BackgroundElderly patients in senior communities faced high barriers to care during the COVID‐19 pandemic, including increased vulnerability to COVID‐19, long quarantines for clinic visits, and difficulties with telemedicine adoption.ObjectiveTo pilot a new model of dermatologic care to overcome barriers for senior living communities during the COVID‐19 pandemic and assess patient satisfaction.MethodsFrom 16 November 2020 to 9 July 2021, this quality improvement programme combined in‐residence full body imaging with real‐time outlier lesion identification and virtual teledermatology. Residents from the Sequoias Portola Valley Senior Living Retirement Community (Portola Valley, California) voluntarily enroled in the Stanford Skin Scan Programme. Non‐physician clinical staff with a recent negative COVID‐19 test travelled on‐site to obtain in‐residence full body photographs using a mobile app‐based system on an iPad called SkinIO that leverages deep learning to analyse patient images and suggest suspicious, outlier lesions for dermoscopic photos. A single dermatologist reviewed photographs with the patient and provided recommendations via a video visit. Objective measures included follow‐up course and number of skin cancers detected. Subjective findings were obtained through patient experience surveys.ResultsTwenty‐seven individuals participated, three skin cancers were identified, with 11 individuals scheduled for a follow up in‐person visit and four individuals starting home treatment. Overall, 88% of patients were satisfied with the Skin Scan programme, with 77% likely to recommend the programme to others. 92% of patients agreed that the Skin Scan photographs were representative of their skin. In the context of the COVID‐19 pandemic, 100% of patients felt the process was safer or comparable to an in‐person visit. Despite overall appreciation for the programme, 31% of patients reported that they would prefer to see dermatologist in‐person after the pandemic.ConclusionsThis programme offers a framework for how a hybrid skin scan programme may provide high utility for individuals with barriers to accessing in‐person clinics.

Caregivers’ Role in Supporting Occupational Therapy Video Telehealth: A Qualitative Study

Background Video telehealth increases access to care for patients living in rural communities and those whose functional status makes attending brick-and-mortar health care visits difficult. This includes many older adults whose accumulated health risks, due to age and chronic illness, may result in higher rates of disability. Older adults underutilize video visits due to decreased digital literacy and age-related impairments. While caregiver assistance may ameliorate such barriers, little is known about the role of caregivers to support patient participation in video telehealth, particularly for more hands-on clinical services such as occupational therapy (OT). Objective This project seeks to explore the role of caregivers to facilitate video telehealth from the perspective of occupational therapy (OT) practitioners at Veterans Health Administration, the largest integrated health care system in the United States. Methods In early 2021, we conducted semistructured interviews with Veterans Health Administration occupational therapy practitioners (n=27) about their experiences using video telehealth to deliver OT services. During the interviews, we asked OT practitioners to describe caregiver involvement in video telehealth. We analyzed the responses related to caregiver participation to better understand the caregivers’ support role in OT video telehealth sessions. Results Interview responses related to caregivers’ participation in video telehealth led to the following three broad findings: (1) caregivers participate in video telehealth sessions to varying degrees and fill a variety of technical and clinical roles; (2) the presence of caregivers allows patients who might otherwise not be able to access telehealth to do so; and (3) there are benefits and barriers to caregiver participation. Related to caregivers’ support roles, our findings revealed that caregivers assist with technical tasks such as logging onto the computer and operating the device to enable visualization during the sessions. The clinical tasks caregivers assist with include communicating with the clinician and taking measurements during home safety evaluations. Factors that appear to contribute to caregiver involvement include patients’ low technical literacy and age- or health-related impairments, such as hearing and vision loss, decreased mobility, or cognitive changes. Perceived benefits included increased caregiver involvement in patient care, while barriers included lack of available caregivers to assist. Conclusions This study improves our understanding of the caregivers’ role supporting patient participation in video telehealth. This foundational work suggests that more studies examining caregiver participation are needed, particularly larger studies and those from the perspectives of caregivers and patients. Elaborating caregiver participation in video telehealth should enable the identification of strategies to facilitate telehealth service delivery, particularly for patients who continue to face access challenges in a post–COVID-19 landscape. Conflict of Interest None declared.

COVID-19 pandemic accelerates the perception of digital transformation on real estate websites.

In early March, the newspapers reported the arrival of the Coronavirus in Brazil. The period of confinement directly affected our routines and transformed our consumption habits. Amidst the fear of contagion and uncertainty, people isolated themselves and postponed changes. Previous studies indicate that digital practices were accelerated after the onset of the COVID-19 pandemic, facilitating communication and improving the performance of various sectors of the economy. Thus, to better understand the behavior of Brazilian real estate market professionals in this period, the objective of this research was to verify whether the COVID-19 pandemic accelerated the process of perception of digitalization in real estate websites. To this end, five experts in the digital real estate market were interviewed, asked what are the main items that a quality real estate website should have to improve user experience. Based on the items selected by the experts, a questionnaire was developed and a question was constructed for each item. The questionnaire was sent online to 2144 realtors, asking about the importance of these items before and after the pandemic started. Using a 5-point Likert scale, and strict criteria for analysis, our survey yielded 423 valid responses. The results indicate that regardless of the groups analyzed, the hypotheses confirm that after the beginning of the COVID-19 pandemic, the perception of the importance of digital technology in Brazilian real estate websites was enhanced, increased. Managers took advantage of the pandemic and the availability of digital technology to offer specialized service to customers, thus creating a new competitive scenario. The tools associated with the visualization of the property and information such as ‘360°/Video Tour’, ‘Video Visit Broadcast’, ‘Chatbots’ and ‘FAQ List’ had the greatest increase in perception.

"I Don't Trust It": Use of a Routine OSCE to Identify Core Communication Skills Required for Counseling a Vaccine-Hesitant Patient.

BackgroundVaccine hesitancy is challenging for clinicians and of increasing concern since COVID-19 vaccination rollout began. Standardized patients (SPs) provide an ideal method for assessing resident physicians’ current skills, providing opportunity to practice and gain immediate feedback, while also informing evaluation of curriculum and training. As such, we designed and implemented an OSCE station where residents were tasked with engaging and educating a vaccine-hesitant patient.AimDescribe residents’ vaccine counseling practices, core communication and interpersonal skills, and effectiveness in meeting the objectives of the case. Explore how effectiveness in overcoming vaccine hesitancy may be associated with communication and interpersonal skills in order to inform educational efforts.SettingAnnual OSCE at a simulation center.Participants106 internal medicine residents (51% PGY1, 49% PGY2).Program DescriptionResidents participated in an annual residency-wide, multi-station OSCE, one of which included a Black, middle-aged, vaccine-hesitant male presenting for a routine video visit. Residents had 10 min to complete the encounter, during which they sought to educate, explore concerns, and make a recommendation. After each encounter, faculty gave residents feedback on their counseling skills and reviewed best practices for effective communication on the topic. SPs completed a behaviorally anchored checklist (30 items across 7 clinical skill domains and 2 measures of trust in the vaccine’s safety and resident) which will inform future curriculum.Program EvaluationFifty-five percent (SD: 43%) of the residents performed well on the vaccine-specific education domain. PGY2 residents scored significantly higher on two of the seven domains compared to PGY1s (patient education/counseling—PGY1: 35% (SD: 36%) vs. PGY2: 52% (SD: 41%), p = 0.044 and activation—PGY1: 37% (SD: 45%) vs. PGY2: 59% (SD: 46%), p = 0.016). In regression analyses, education/counseling and vaccine-specific communication skills were strongly, positively associated with trust in the resident and in the vaccine’s safety. A review of qualitative data from the SPs’ perspective suggested that low performers did not use patient-centered communication skills.DiscussionThis needs assessment suggests that many residents needed in-the-moment feedback, additional education, and vaccine-specific communication practice. Our program plans to reinforce evidence-based practices physicians can implement for vaccine hesitancy through ongoing curriculum, practice, and feedback. This type of needs assessment is replicable at other institutions and can be used, as we have, to ultimately shed light on next steps for programmatic improvement.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07495-4.

Rapid Implementation of Telehealth Video Visits in Cancer Care - The Perspectives of Patients and Healthcare Professionals

Rapid Implementation of Telehealth Video Visits in Cancer Care - The Perspectives of Patients and Healthcare Professionals

Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study.

PurposeTelemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic.MethodsWe conducted a cross-sectional analysis of nationwide survey data assessing telemedicine use in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) in December 2020. Patients were characterized as financially distressed by self-reporting limited financial resources to manage out-of-pocket costs, psychological distress, and/or adaptive coping behaviors. Primary study outcome was telemedicine utilization during the pandemic. Secondary outcomes were telemedicine utilization volume and modality preferences. Multivariable and Poisson regression analyses were used to identify factors associated with telemedicine use.ResultsA convenience sample of 627 patients with cancer responded to the PAF survey. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (19–35 age compared to ≥ 75 age) (OR, 6.07; 95% CI, 1.47–25.1) and more comorbidities (≥ 3 comorbidities compared to cancer only) (OR, 1.79; 95% CI, 1.13–2.65) were factors associated with telemedicine adoption. Younger age (19–35 years) (incidence rate ratios [IRR], 1.78; 95% CI, 24–115%) and higher comorbidities (≥ 3) (IRR; 1.36; 95% CI, 20–55%) were factors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95% CI, 1.03–1.05).ConclusionsThe rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially distressed patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-07204-1.

Quality of virtual care for ambulatory care sensitive conditions: Patient and provider experiences

BackgroundThe COVID-19 pandemic and the need for physical distancing has led to rapid uptake of virtual visits to deliver ambulatory health care. Despite widespread adoption, there has been limited evaluation of the quality of care being delivered through virtual modalities for ambulatory care sensitive conditions (ACSCs). ObjectiveTo characterize patients’ and providers’ experiences with the quality and sustainability of virtual care for ACSCs. DesignThis was a multi-method study utilizing quantitative and qualitative data from patient surveys, provider surveys, and provider focus groups at a large academic ambulatory care hospital between May 2020 and June 2021. We included patients and providers utilizing telephone or video visits for the following ACSCs: hypertension, angina, heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, or asthma. Main measuresQuantitative and qualitative patient and provider survey responses were mapped to the Six Domains of Healthcare Quality framework. Provider focus groups were coded to identify themes within each quality domain. Key resultsSurveys were completed by 110/352 (31%) consenting patients and 20/61 (33%) providers. 5 provider focus groups were held with 14 participants. Patients found virtual visits to be generally more convenient than in-person visits for ACSCs. The perceived effectiveness of virtual visits was dependent on the clinical and social complexity of individual encounters. Respondents reported difficulty forming effective patient-provider relationships in the virtual environment. Patients and providers felt that virtual care has potential to both alleviate and exacerbate structural barriers to equitable access to care. ConclusionsIn a large academic ambulatory care hospital, patients and providers experienced the quality of virtual visits for the management of ACSCs to be variable depending on the biopsychosocial complexity of the individual encounter. Our findings in each quality domain highlight key considerations for patients, providers and institutions to uphold the quality of virtual care for ACSCs.

Telemedicine evaluation of new head and neck patients at a tertiary academic clinic during the coronavirus disease 2019 pandemic

Introduction Coronavirus disease 2019 accelerated the use of virtual visits within health care. We examined the utility of telemedicine for conducting visits in a tertiary head and neck practice. Methods A retrospective study was conducted on patients presenting via video to a tertiary-level head and neck clinic between January 2020 and December 2020. Patient demographics were collected in addition to visit indication, diagnostic imaging/tests at the time of visit, and post-visit plan. Visits were deemed successful if evaluation by video was sufficient in determining a clinical plan and did not require deferment of recommendations for subsequent in-person consult visits and/or work-up (labs, imaging). Logistic regression was performed to identify variables that served as significant predictors of successful video visits. Results A total of 124 video visits were reviewed. Video visits were successful for the initial evaluation 88.7% of the time (n = 110). Computerized tomographic scans were the most available diagnostic test, available for 54% of patients (n = 67), followed by biopsy report 30.6% (n = 38). Visit indication had a statistically significant effect on whether a treatment plan could be made (p = 0.024). For new patients with parotid masses (n = 42), definitive treatment plans could be made 97.6% of the time (n = 41). Patients presenting with an indication of thyroid mass (odds ratio: 0.19 (confidence interval: 0.00072–0.50), p = 0.018) and other neck mass (odds ratio: 0.035 (confidence interval: 0.0014, 0.90), p = 0.043) were at significantly lesser odds than parotid patients to have a successful video visit. Discussion In this study, virtual visits were successful for a high percentage of head and neck visits, particularly among patients seeking evaluation for parotid-related concerns.

Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

BackgroundTelemedicine expanded rapidly during the COVID-19 pandemic, including for contraceptive services. Data are needed to understand whether young people can access telemedicine for contraception, especially in underserved populations.ObjectiveTo compare young people’s perceived access to telemedicine visits for contraception during the COVID-19 pandemic by food and housing insecurity.DesignSupplementary study to a cluster randomized controlled trial in 25 community colleges in California and Texas. Online surveys were administered May 2020 to April 2021. Mixed-effects logistic regression models with random effects for site were used to examine differences in access to contraception through telemedicine by food and housing insecurity status, controlling for key sociodemographic characteristics, including race/ethnicity, non-English primary language, health insurance status, and state of residence, and contraceptive method used.Participants1,414 individuals assigned female at birth aged 18–28.Main MeasuresSurvey measures were used to capture how difficult it would be for a participant to have a telemedicine visit (phone or video) for contraception.Key ResultsTwenty-nine percent of participants were food insecure, and 15% were housing insecure. Nearly a quarter (24%) stated that it would be difficult to have a phone or video visit for contraception. After accounting for sociodemographic factors and type of method used, food insecure (adjusted odds ratio [aOR], 2.17; 95% confidence interval [CI], 1.62–2.91) and housing insecure (aOR, 1.62; 95% CI, 1.13–2.33) participants were significantly more likely to report that it would be difficult to use telemedicine for contraception during the pandemic.ConclusionsUnderserved patients are those who could benefit most from the expansion of telemedicine services, yet our findings show that young people experiencing basic needs insecurity perceive the greatest difficulty accessing these services for essential reproductive care.Trial RegistrationClinicalTrials.gov Identifier: NCT03519685

CONTINUUM: A pilot care transition intervention for hospitalized patients with advanced cancer.

1534 Background: Patients with advanced cancer are frequently hospitalized and experience burdensome transitions of care after discharge. Interventions to address patients’ symptoms, support medication management, and ensure continuity of care after discharge are lacking. We sought to demonstrate the feasibility and acceptability of CONTINUUM (CONTINUity of care Under Management by video visits) for this population. Methods: We conducted a single-arm pilot trial (n = 54) of CONTINUUM at Massachusetts General Hospital (MGH). The intervention consisted of a video visit with an oncology nurse practitioner (NP) within 3 business days of hospital discharge to address symptoms, medication management, hospitalization-related issues, and care coordination. Prior to discharge, we enrolled English-speaking adults with advanced breast, gastrointestinal, genitourinary, or thoracic cancers experiencing an unplanned hospitalization who were receiving ongoing oncology care at MGH and being discharged home without hospice services. We defined the intervention as feasible if ≥70% of approached and eligible patients enrolled and if ≥70% of enrolled patients completed the intervention within 3 business days of discharge. At 2 weeks after discharge, patients rated the ease of use of the video technology and stated whether they would recommend the intervention. NPs completed post-intervention surveys to assess fidelity to the intervention protocol. Results: From 01/07/21 to 05/28/21, we enrolled 54 patients (77.3% of patients approached). Of the enrolled patients (median age = 65.0 years; 59.3% and 22.2% had advanced gastrointestinal or thoracic cancers, respectively), 83.3% of enrolled patients received the intervention within 3 business days of discharge. Patient rating of the ease of use of video technology was a mean of 7.8 out of 10, with 71.4% stating they “agreed” or “strongly agreed” that they would recommend the intervention. NP post-intervention surveys revealed that visits focused on symptom management (85.7%), followed by addressing post-hospital care issues (69.0%). At 30 day follow up, 38.8% were readmitted within 30 days of discharge, and 12.2% died within 30 days of discharge. Conclusions: We found that CONTINUUM, which consists of an NP-delivered video visit soon after hospital discharge addressing patients’ symptoms, medications, and care coordination, represents a feasible and acceptable approach to provide post-discharge care for hospitalized patients with advanced cancer. Future studies will test the efficacy of the intervention for reducing hospital readmissions. Clinical trial information: NCT04640714.

Responses to telehealth expansion for older adults with cancer during the COVID-19 pandemic.

1591 Background: Synchronous video visits (“telehealth”) were rapidly adopted to facilitate provision of cancer care during the COVID-19 pandemic, with little time to comprehensively assess patient and provider needs. Attitudes toward telehealth use during active treatment (vs. survivorship care) were largely unknown, as were perceptions of, experiences with, and needed support for telehealth use among older adults with cancer. Older adults in particular may face increased vulnerability to inequities in access to care due to limited digital literacy. Methods: We conducted surveys and semi-structured interviews with providers, staff, and older patients (age ≥60) from a comprehensive cancer center. Data collection occurred between Dec 2020 - Nov 2021. Results: We completed a total of 106 provider/staff surveys, 128 patient surveys, 20 provider/staff interviews, and 15 patient interviews. A majority of surveyed providers/staff felt that telehealth should “definitely be offered” during treatment-phase encounters (55.9% treatment follow-up; 69.1% results communication; 70.2% discussing treatment side effects). Similarly, most patients indicated they would be willing to have video visits with a member of their care team for: discussing treatment side-effects (73.5%), results communication (69.6%), and treatment follow-up (65.7%). Patients reported experiencing challenges with joining video visits (29%) and understanding the telehealth process (28%). Similarly, less than a third (30.8%) of providers/staff agreed or strongly agreed that the institution did a good job of preparing patients for their first telehealth encounter. Patients felt the institution should do more to communicate the advantages of telehealth to older adults in handouts and videos, which included: engaging multiple family members in critical appointments (e.g., treatment decisions, end-of-life), seeing their doctor when they were too sick to travel, and reducing potential exposure to infectious disease at the clinic. Participants suggested several strategies to assist patients with limited digital literacy: offering video tutorials of the connection process, creating “fake appointments” to practice online connections, and hiring a digital navigator to assist with technical difficulties and setup of the online portal. Despite challenges, a majority of surveyed patients (65.7%) and providers/staff (76.9%) intend to continue using telehealth after the COVID-19 pandemic passes. Conclusions: Use of telehealth for cancer care was received positively by older patients and providers/staff. Taking targeted steps to enhance implementation could reduce barriers to care, including among older adults and other populations with limited digital literacy, thereby promoting greater equity of access to telehealth benefits beyond the pandemic.

Evaluation of a pharmacist-led video consultation to identify drug interactions among patients initiating oral anticancer drugs.

1592 Background: The past decade has seen a dramatic increase in the number of oral anti-cancer drug (OACD) approvals in the United States. Though polypharmacy and drug-drug interactions (DDIs) likely contribute to OACD toxicity, the prevalence of these features in patients on OACDs remains largely unknown. We aimed to evaluate a one-time 30-minute pharmacist-led video consultation among metastatic cancer patients initiating OACDs to identify medication list inaccuracies as well as the prevalence, characteristics, and severity of OACD-related potential DDIs. Methods: We conducted a single-arm, prospective telehealth intervention study among 29 patients initiating OACDs to evaluate a one-time 30-minute pharmacist-led video consultation. The video visits focused on identifying and discussing polypharmacy and potential DDIs, and pharmacists then communicated recommendations to each patient's oncologist. We estimated the prevalence, characteristics (QTc prolongation, absorption interactions, etc.), and severity of OACD-related potential DDIs. Lexicomp and Micromedex were used to assess potential DDIs and measure severity on a standardized scale (A – D, X). In addition, we assessed the prevalence of medication list inaccuracies, polypharmacy, and patient satisfaction. Results: Twenty-five patients completed the intervention (86% completion rate) of whom 40% were 75 years of age or older and 60% were men. The majority were white (68%) and non-Hispanic (76%). Sixteen patients (68%) had a solid tumor diagnosis. Nearly half (48%) were insured by Medicare. The median number of medications per patient was 9 with a range of 4 – 21, and 96% of patients had at least 5 prescriptions listed. The median number of medication list errors was 2 with a range of 0 – 16, with at least 1 error for 76% and more than 1 error for 52% of patients. Pharmacists identified potential OACD-related interactions in 9 cases (40%). These included change in drug absorption or metabolism (7), QTc prolongation (1), hypotension (1), and bleeding (1). Interactions were classified as either category C (8) or D (2), requiring close monitoring or a change in treatment, respectively. All patients expressed a high level of satisfaction with the video visit. Conclusions: Polypharmacy, medication list errors, and potential DDIs are prevalent among patients initiating OACDs despite use of an electronic medical record requiring medication reconciliation. Our study suggests that a one-time remote 30-minute pharmacist-led video consultation can effectively identify and address OACD-related potential DDIs, which may decrease medication complexity and improve adherence in this population.

Telehealth cognitive-behavioral therapy for cancer-related cognitive impairment: A model for remote clinical trial participation.

TPS12143 Background: Cancer-related cognitive impairment (CRCI) can include persistent memory symptoms, and affects many cancer survivors. Memory and Attention Adaptation Training (MAAT) is an evidence-based cognitive behavioral therapy (CBT) that improves CRCI with demonstrated efficacy in telehealth delivery. MAAT consists of 8 weekly (45-minute) video visits. The aims of this study are to confirm MAAT telehealth efficacy in a phase III RCT (MAAT versus Supportive Therapy; ST) across large catchment areas of two comprehensive cancer centers. A secondary aim is to evaluate treatment-induced brain activation as assessed by functional MRI (fMRI) in a subset of participants. We present remote treatment and data capture methods of this open NCI-sponsored (R01CA244673) randomized clinical trial (NCT 04586530). These methods have high success in participant accrual despite COVID-19 pandemic conditions, and can be readily adopted to other clinical trials to enhance rural/underserved enrollment. Methods: We are enrolling 200 adult, stage I-III breast cancer survivors 1-5 years post-chemotherapy with cognitive complaints. Individuals with CNS disease, previous brain injury, dementia or psychiatric disorder are excluded. All study procedures are completed from the participant’s home (except fMRI). Eligibility screening is a semi-structured phone interview followed by detailed informed consent online (Research Electronic Data Capture: REDCap) with staff phone guidance. Consented participants complete baseline brief phone-based neurocognitive assessment and validated patient-reported outcome measures (PROs) of cognition and quality of life via REDCap. Participants are randomized to MAAT or ST and assigned treating clinicians at respective cancer centers. All 8 visits are completed through secure telehealth platforms, followed by repeat phone/online assessment post-treatment and again at 6 months. Enrollment began in 3/2021. As of 1/2022 (9 months), 56 participants are enrolled (28% of the planned sample), 47 randomized (MAAT 24; ST 23), with 24 completing post-treatment assessments. If all assessments and treatment visits were in person, travel burden per participant is 968 miles/20.5 hours driven, and $542 (US 2021 Federal rate). Thus, study travel savings to date are $30,352. Participant feedback indicates telehealth makes participation possible, similar to previous MAAT research. The current RCT demonstrates utility, efficiency and cost-savings of telehealth and remote data capture technology in the conduct of cancer control research. Elements of methods described can also be adopted for cancer therapeutic trials. Comprehensive cancer centers, where most clinical trials are based, can enhance participation of remote and/or underserved populations that have higher rates of cancer, more disease burden and less opportunity for trial participation. Clinical trial information: NCT04586530.

Telemedicine adoption and utilization among financially distressed patients with cancer during the COVID-19 pandemic: Insights from a longitudinal nationwide survey.

1596 Background: Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. Methods: We conducted an analysis of survey data assessing the use of telemedicine in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) from May 2020 to December 2020. Primary study outcome was telemedicine utilization rate. Secondary outcomes were independent predictors of telemedicine utilization patterns, volume, and utilization preferences. Multivariate and poisson regression analyses were used to identify predictive factors. Results: Of the 1,390 respondents, 627 completed two survey waves and were included in this study. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (odds ratio, 6.07; 95% CI, 1.47-25.1), and higher comorbidities (odds ratio, 1.79; 95% CI, 1.13-2.65) were independent predictors associated with telemedicine adoption. Younger age (19-35 yrs.) (incidence rate ratios [IRR], 1.78; 95%CI, 24-115%) and higher comorbidities (≥3) (IRR; 1.36; 95%CI, 20-55%) were independent predictors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95%CI, 1.03-1.05). Conclusions: The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially under-resourced patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.