medwireNews: Black patients, those with Medicaid insurance, and those living in disadvantaged areas are less likely to have a successful thoracic oncology telemedicine visit than other patients, US research suggests.
Furthermore, not completing these visits is associated with an increased risk for poor outcomes, report Josephine Feliciano (Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland) and co-authors in JAMA Network Open.
Their study included 720 patients (median age 65.7 years, 53% men) with thoracic tumors (most commonly non-small-cell lung cancer, in 72%) who attended 1940 outpatient visits at the Johns Hopkins Medical Institute between March and July 2020.
Most (65.0%) of the visits during this period were conducted via telemedicine, with 35.0% carried out in person.
The overall success rate for telemedicine visits, defined as completing the full scheduled visit using video capability, was 56.9%. Among the unsuccessful visits, 91.2% were conducted via telephone instead and 8.8% were missed appointments.
Patients who were Black were significantly less likely than White patients to have a successful telemedicine visit, at an odds ratio (OR) of 0.62. The likelihood of a successful visit was also significantly lower among individuals with Medicaid rather than private health insurance (OR=0.38), and among those who were from a zip code with an increased risk for cancer mortality (OR=0.51).
Conversely, patients who were married or partnered were significantly more likely to have successful telemedicine visits than those who were not (OR=1.62).
When looking at clinical outcomes, the researchers found that patients with one unsuccessful telemedicine visit out of multiple scheduled visits had a significantly increased likelihood of visiting the emergency department (OR=2.22) or an urgent care setting (OR=2.81), or requiring hospitalization (OR=2.97) than those with successful visits on every occasion.
The corresponding ORs were generally higher among people with more than one unsuccessful visit, at 2.73, 4.50, and 2.37, and higher still, at 3.43, 4.24, and 4.19, for those with no successful telemedicine visits.
In addition, the risk for death was significantly lower among patients with successful telemedicine visits on every occasion relative to those with in-person visits (OR=0.52), as well as among those with only one unsuccessful telemedicine visit (OR=0.32).
“These findings suggest that more work is needed to improve telemedicine access for disadvantaged patients,” Feliciano et al conclude.
In an accompanying comment, Howard West (City of Hope Comprehensive Cancer Center, Duarte, California, USA) says that the study “represents an important step in the evolution of the field of telemedicine because it seeks to address the questions of which patients are well or poorly served by current models of telemedicine delivery and whether successful delivery of telemedicine is associated with distinct profiles of clinical outcomes.”
However, he questions “whether a telephone-based visit truly represents a failed telemedicine encounter and should serve as the cornerstone of an analysis assessing associations with patient demographics and clinical outcomes.”
West remarks: “Telemedicine is not the right tool for every job, but neither is in-person care; by the same token, telephone-based care is well suited for some tasks, constituting a legitimate if not always ideal component of telemedicine.”
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JAMA Netw Open 2022; 5: e2220543
JAMA Netw Open 2022; 5: e2220550