Brookdale Department of Geriatrics and Palliative Medicine (J.L.F.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy (A.B., M.M.), Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery, New York, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (A.B., B.L., M.M.), New York, New York, USA; Department of Population Health Science and Policy (B.L.), Icahn School of Medicine at Mount Sinai, Institute for Translational Epidemiology, New York, New York, USA; Ann B. Barshinger Cancer Institute (B.M.S.), University of Pennsylvania Health System, Lancaster, Pennsylvania, USA; Division of Hematology and Oncology, Department of Medicine (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Brookdale Department of Geriatrics and Palliative Medicine (J.L.F.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy (A.B., M.M.), Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery, New York, New York, USA; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (A.B., B.L., M.M.), New York, New York, USA; Department of Population Health Science and Policy (B.L.), Icahn School of Medicine at Mount Sinai, Institute for Translational Epidemiology, New York, New York, USA; Ann B. Barshinger Cancer Institute (B.M.S.), University of Pennsylvania Health System, Lancaster, Pennsylvania, USA; Division of Hematology and Oncology, Department of Medicine (C.B.S.), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Pain Symptom Manage. 2022 Mar;63(3):423-429. doi: 10.1016/j.jpainsymman.2021.09.019. Epub 2021 Oct 10.
Given a shortage of specialty palliative care clinicians and geographic variation in availability, telemedicine has been proposed as one way to improve access to palliative care services for patients with cancer. However, the enduring digital divide raises questions about whether unequal access will exacerbate healthcare disparities.
To examine factors associated with utilization of telemedicine as compared to in-person visits by patients with cancer in the ambulatory palliative care setting.
We collected data on patients seen in Supportive Oncology clinic by palliative care clinicians with an in-person or telemedicine visit from March 1 to December 30, 2020. A logistic regression with generalized estimating equation was fit to assess the association between visit type and patient characteristics.
A total of 491 patients and 1783 visits were identified, including 1061 (60%) in-person visits and 722 (40%) telemedicine visits. Female patients were significantly more likely to utilize telemedicine than male patients (OR 1.46; 95% CI 1.11-1.90). Spanish-speaking patients (OR 0.32, 95% CI 0.17-0.61), those without insurance (OR 0.28, 95% CI 0.15-0.52), and those without an activated patient portal (Inactivated: OR 0.46, 95% CI 0.26-0.82; Pending Activation: OR 0.29, 95% CI 0.18-0.48) were less likely to utilize telemedicine.
Our study reveals disparities in telemedicine utilization in the ambulatory palliative care setting for patients with cancer who are male, Spanish-speaking, uninsured, or do not have an activated patient portal. In the wake of the COVID-19 pandemic, we can better meet the palliative care needs of patients with cancer through telemedicine only if equity is kept at the forefront of our discussions.
鉴于专科姑息治疗临床医生短缺以及地域间可及性的差异，远程医疗已被提议作为改善癌症患者获得姑息治疗服务的一种方式。然而，持续存在的数字鸿沟引发了这样的问题，即不平等的获取途径是否会加剧医疗保健方面的差异。
在姑息治疗门诊环境中，调查癌症患者利用远程医疗与门诊就诊的相关因素。
我们收集了 2020 年 3 月 1 日至 12 月 30 日期间，姑息治疗临床医生通过门诊或远程医疗方式为支持性肿瘤学门诊就诊的患者进行的就诊数据。采用广义估计方程的逻辑回归分析来评估就诊类型与患者特征之间的关联。
共确定了 491 名患者和 1783 次就诊，其中 1061 次（60%）为门诊就诊，722 次（40%）为远程医疗就诊。与男性患者相比，女性患者更倾向于利用远程医疗就诊（OR 1.46；95%CI 1.11-1.90）。西班牙语患者（OR 0.32，95%CI 0.17-0.61）、无保险者（OR 0.28，95%CI 0.15-0.52）和未激活患者门户者（未激活：OR 0.46，95%CI 0.26-0.82；待激活：OR 0.29，95%CI 0.18-0.48）较少利用远程医疗。
我们的研究揭示了在姑息治疗门诊环境中，癌症患者利用远程医疗存在差异，这些差异与患者的性别、西班牙语使用情况、保险状况和患者门户激活情况有关。在 COVID-19 大流行之后，只有将公平性放在讨论的首位，我们才能通过远程医疗更好地满足癌症患者的姑息治疗需求。
