Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care.

Autor: De B; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Fu S; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Chen YS; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Das P; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Ku K; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Maroongroge S; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Woodhouse KD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Hoffman KE; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Nguyen QN; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Reed VK; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Chen AB; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Koong AC; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Smith BD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Smith GL; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: Cancer medicine [Cancer Med] 2022 May; Vol. 11 (10), pp. 2096-2105. Date of Electronic Publication: 2022 Mar 16.
DOI: 10.1002/cam4.4555
Abstrakt: Background: Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer.
Methods: Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes.
Results: Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (p trend  < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national "Opening Up America Again" guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03-4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1-5 fractions (OR = 4.49, 95% CI 2.29-8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons).
Conclusion: Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount-and not exacerbate-barriers to quality cancer care.
(© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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