Growth of telehealth in cancer care continued after initial surge during COVID-19 pandemic
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Key takeaways:
- Telehealth use increased from less than 0.01% in 2019 to 11% in 2020 and 14% in 2021 across a multiregional cancer practice.
- Staff physicians used telehealth more frequently than advanced practice providers.
After an initial pandemic-related surge, demand for telehealth services among patients with cancer remained strong even as the COVID-19 emergency waned, according to an analysis of utilization in one multiregional health care system.
Incorporation of telehealth visits during the pandemic did not result in redundant care as determined by per-physician patient volume, data published in JCO Oncology Practice revealed.
“There’s a big difference in the world we live in now compared with 2020 or 2021,” Tufia C. Haddad, MD, associate professor of oncology and chair of practice innovation and platform at Mayo Clinic Comprehensive Cancer Center, told Healio.
"For maintaining established patients, I believe we will continue to see utilization of telehealth visits in the broader cancer practice,” she added. “I anticipate that we will see a decline in using telehealth for new patient consultations or second-opinion consults.
Background and methodology
Haddad and colleagues conducted a multicenter retrospective cross-sectional analysis to assess changes in telehealth utilization over time.
"We wanted to understand if there were specific patient or provider factors that drove utilization of telehealth visits — whether it be phone or video visits,” Haddad said. "We wanted to determine the drivers of adoption and whether they changed over time."
The study included outpatient visits at one of three tertiary hospitals (Minnesota, Florida or Arizona) or community-based facilities in Mayo Clinic Health System.
Investigators began their multivariate analysis of patient- and provider-level variables and outpatient visits over an initial 8-week period from July to August 2019 (n = 32,537), and compared this with the same time periods in 2020 (n = 33,399) and 2021 (n = 35,820).
Key findings
Results showed the telehealth utilization rate increased from less than 0.01% in 2019 — prior to the start of the COVID-19 pandemic — to 11% in 2020. Telehealth utilization continued its ascent the following year, accounting for 14% of visits at participating study sites in 2021.
Physicians used telehealth visits significantly more than advanced practice providers in both 2020 (13% vs. 7%; P < .001) and 2021 (18% vs. 8%; P < .001).
Patients aged 65 years or younger used video telehealth visits significantly more than those aged 65 or older in both 2020 (OR = 1.02; 95% CI, 1-1.03) and 2021 (OR = 1.03; 95% CI, 1.01-1.05).
Investigators reported significantly more video telehealth visits among nonrural patients in 2020 (OR = 1.04; 95% CI, 1.02-1.05) and 2021 (OR = 1.02; 95% CI, 1-1.03), whereas rural patients used phone for telehealth visits significantly more than nonrural residents in both 2020 (OR = 0.97; 95% CI, 0.96-0.98) and 2021 (OR = 0.97; 95% CI, 0.96-0.98).
Visit volume initially increased across all appointment types, from 1.24 appointments per patient in 2019 to 1.25 in 2020. This decreased to 1.23 during 2021, lower than the prepandemic level.
Clinical implications
“Now that the public health emergency has expired, some of the licensure requirements that were relaxed allowing the use of telehealth across state lines are beginning to roll back to prepandemic levels,” Haddad told Healio. “With this in mind, I believe we will see a drop in volume from telehealth, including visits from across state lines.”
The fact that people in rural communities opted for phone telehealth more often showed a willingness to adopt telehealth visits, according to Haddad. Nevertheless, the study results suggest there are existing barriers to wider adoption of video telehealth among some rural-based individuals.
Further studies should look at whether these issues are the result of broadband availability or technology/health care literacy, she added.
“There is definitely a higher level of digital health literacy required for a video health visit compared with picking up the telephone,” Haddad said. “This is an area in need of more research to determine what is driving the challenges to video adoption.”
For more information:
Tufia C. Haddad, MD, can be reached at Mayo Clinic, Department of Oncology, 200 First St., SW, Rochester, MN 55905; email: haddad.tufia@mayo.edu.
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