Trends and disparities in oncology telehealth after the initial pandemic era.
Authors: Lee Michael Jisoo , Lyon Liisa , Conell Carol Andrea , Sun Hongxin , Anderson Brandon , Neeman Elad , Kumar Deepika , Kotak Dinesh , Shiraz Aida , Reed Mary , Liu Raymond 
Published: June 2023

1606

Background: While the COVID pandemic elevated the usage of telehealth to unprecedented levels, it remains unclear whether telehealth use is sustained after the initial pandemic era, and whether there remain demographic differences in telehealth utilization. In this study, we compared telehealth trends amongst different demographic populations in a large integrated healthcare system. Methods: Utilization of various visit types (office, video, telephone) was investigated in this population-based retrospective cohort study at 22 Kaiser Permanente Northern California Hematology and Oncology clinics from 10/1/2020 to 6/1/2022. We explored trends associated with the COVID 19 pandemic and after the initial pandemic era as well as demographic differences, using Chi-square for categorical and the Mann-Whitney U Test for non-parametric comparisons. Results: During the study period, there were 341,089 hematology/oncology visits with MD/DO providers, including 83,756 (24.5%) office, 125,162 (36.7%) video, and 132,171 (38.7%) telephone. Total monthly visits remained stable, with a monthly average of 1,765 (10.9%) for new visits and 14,476 (89.1%) for return visits. Monthly telehealth visits (telephone + video) peaked in January, 2021 (85.6% of total visits) and subsequently declined by June, 2022 (68.7% of total visits). Telephone visits increased from 46.1% of telehealth visits to 58.9% over the study period. Amongst telehealth visits, video visits remained popular for new appointments (56.9%) while telephone visits were more common for return appointments (60.7%). After the initial pandemic era, telehealth utilization continued to differ amongst different demographic populations. Video visits remained a significantly higher fraction of all visits (p<0.01) in: (1) less than 45 year-old (60.0%) compared to older than 80 year-old (33.2%); (2) primary English speakers (50.7%) compared to those who require an interpreter (41.5%); (3) patients with commercial insurance (58.2%) compared to those with Medicaid (47.0%) or Medicare (45.2%); (4) non-Hispanic Whites (51.4%) and Asians (52.2%) compared to Hispanic Whites (45.0%) and Blacks (43.6%); (5) patients with the lowest neighborhood deprivation index (NDI) quartile (living in the least deprived neighborhood) (54.0%) vs the highest quartile (46.1%). Conclusions: After the initial pandemic era, telehealth utilization declined slightly over time but remained a common method of providing oncology care. Video visits continued to be widely utilized for initial visits whereas there was a shift to telephone visits for follow up appointments over time. Disparities in telehealth, especially in video visits, continued to be seen in various demographic populations by age, English proficiency, insurance plan, race/ethnicity and neighborhood deprivation index. Continued high utilization of telehealth should inform policy and practices in the post-pandemic era.