Patient-related barriers to some virtual healthcare services among cancer patients in the USA: a population-based study
Publication: Journal of Comparative Effectiveness Research
Abstract
Objective: To assess the patient-related barriers to access of some virtual healthcare tools among cancer patients in the USA in a population-based cohort. Materials & methods: National Health Interview Survey datasets (2011–2018) were reviewed and adult participants (≥18 years old) with a history of cancer diagnosis and complete information about virtual healthcare utilization (defined by [a] filling a prescription on the internet in the past 12 months and/or [b] communicating with a healthcare provider through email in the past 12 months) were included. Information about video-conferenced phone calls and telephone calls are not available in the National Health Interview Survey datasets; and thus, they were not examined in this study. Multivariable logistic regression analysis was used to evaluate factors associated with the utilization of virtual care tools. Results: A total of 25,121 participants were included in the current analysis; including 4499 participants (17.9%) who utilized virtual care in the past 12 months and 20,622 participants (82.1%) who did not utilize virtual care in the past 12 months. The following factors were associated with less utilization of virtual healthcare tools in multivariable logistic regression: older age (continuous odds ratio [OR] with increasing age: 0.987; 95% CI: 0.984–0.990), African-American race (OR for African American vs white race: 0.608; 95% CI: 0.517–0.715), unmarried status (OR for unmarried compared with married status: 0.689; 95% CI: 0.642–0.739), lower level of education (OR for education ≤high school vs >high school: 0.284; 95% CI: 0.259–0.311), weaker English proficiency (OR for no proficiency vs very good proficiency: 0.224; 95% CI: 0.091–0.552) and lower yearly earnings (OR for earnings <$45,000 vs earnings >$45,000: 0.582; 95% CI: 0.523–0.647). Conclusion: Older patients, those with African-American race, lower education, lower earnings and weak English proficiency are less likely to access the above studied virtual healthcare tools. Further efforts are needed to tackle disparities in telemedicine access.
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References
Papers of special note have been highlighted as: • of interest
1.
Bunnell CA, Weingart SN, Swanson S, Mamon HJ, Shulman LN. Models of multidisciplinary cancer care: physician and patient perceptions in a comprehensive cancer center. J. Oncol. Pract. 6(6), 283–288 (2010).
2.
Whear R, Thompson-Coon J, Rogers M et al. Patient-initiated appointment systems for adults with chronic conditions in secondary care. Cochrane Database Syst. Rev. 4, Cd010763 (2020).
3.
Lambertini M, Toss A, Passaro A et al. Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: young oncologists' perspective. ESMO Open 5(2), e000759 (2020).
4.
Shankar A, Saini D, Roy S et al. Cancer care delivery challenges amidst coronavirus disease-19 (COVID-19) outbreak: specific precautions for cancer patients and cancer care providers to prevent spread. Asian Pac. J. Cancer Prev. 21(3), 569–573 (2020).
5.
Liang W, Guan W, Chen R et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 21(3), 335–337 (2020).
6.
Bai Y, Yao L, Wei T et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 323(14), 1406–1407 (2020).
7.
Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N. Engl. J. Med. 382(18), 1679–1681 (2020).
• Reviews current telemedicine practices in the context of COVID-19.
8.
Gadzinski AJ, Ellimoottil C, Odisho AY, Watts KL, Gore JL. Implementing telemedicine in response to the 2020 COVID-19 pandemic. J. Urol. 204(1), 14–16 (2020).
9.
Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveill. 6(2), e18810 (2020).
10.
Karacin C, Bilgetekin I, Basal FB, Oksuzoglu OB. How does COVID-19 fear and anxiety affect chemotherapy adherence in patients with cancer. Future Oncol. 16(29), 2283–2293 (2020).
11.
Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19. JAMA Oncol. 16(18), 1225–1227 (2020).
12.
Ownsworth T, Chan RJ, Jones S, Robertson J, Pinkham MB. Use of telehealth platforms for delivering supportive care to adults with primary brain tumors and their family caregivers: a systematic review. Psychooncology (2020) (Epub ahead of print).
13.
National Health Interview Survey (2020). www.cdc.gov/nchs/nhis/about_nhis.htm
14.
Abdel-Rahman O. Socioeconomic predictors of suicide risk among cancer patients in the United States: a population-based study. Cancer Epidemiol. 63, 101601 (2019).
15.
Abdel-Rahman O. Outcomes of non-metastatic colon cancer patients in relationship to socioeconomic status: an analysis of SEER census tract-level socioeconomic database. Int. J. Clin. Oncol. 24(12), 1582–1587 (2019).
16.
Abdel-Rahman O. Impact of NCI socioeconomic index on the outcomes of nonmetastatic breast cancer patients: analysis of SEER census tract-level socioeconomic database. Clin. Breast Cancer 19(6), e717–e722 (2019).
17.
Li Q, Guan X, Wu P et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N. Engl. J. Med. 382(13), 1199–1207 (2020).
18.
Granhagen Jungner J, Tiselius E, Blomgren K, Lutzen K, Pergert P. Language barriers and the use of professional interpreters: a national multisite cross-sectional survey in pediatric oncology care. Acta Oncol. 58(7), 1015–1020 (2019).
19.
Adler E, Alexis C, Ali Z et al. Bridging the distance in the Caribbean: telemedicine as a means to build capacity for care in paediatric cancer and blood disorders. Stud. Health Technol. Inform. 209, 1–8 (2015).
20.
Brous E. Legal considerations in telehealth and telemedicine. Am. J. Nurs. 116(9), 64–67 (2016).
21.
Becker CD, Dandy K, Gaujean M, Fusaro M, Scurlock C. Legal perspectives on telemedicine part 1: legal and regulatory issues. Perm. J. 23, 18–293 (2019).
22.
Becker CD, Dandy K, Gaujean M, Fusaro M, Scurlock C. Legal perspectives on telemedicine part 2: telemedicine in the intensive care unit and medicolegal risk. Perm. J. 23, 18–294 (2019).
23.
Ngo-Metzger Q. Breaking bad news over the phone. Am. Fam. Physician 80(5), 520 (2009).
24.
Wolf I, Waissengrin B, Pelles S. Breaking bad news via telemedicine: a new challenge at times of an epidemic. Oncologist 25(6), e879–e880 (2020).
25.
Orlando JF, Beard M, Kumar S. Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health. PLoS ONE 14(8), e0221848 (2019).
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Pages: 119 - 126
PubMed: 33448874
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© 2021 Future Medicine Ltd.
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Received: 27 August 2020
Accepted: 27 October 2020
Published online: 15 January 2021
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Patient-related barriers to some virtual healthcare services among cancer patients in the USA: a population-based study. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2020-0187
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