Black and Hispanic Patients Use Telehealth Less Than White Patients During COVID-19 Pandemic

Compared with white patients, Black and Hispanic patients with cancer used telehealth less during the peak of the coronavirus disease 2019 (COVID-19) pandemic, according to findings from an analysis of data from New York City hospitals presented as part of the virtual 2020 American Society of Clinical Oncology (ASCO) Quality Care Symposium.¹

“In a world where telehealth is needed because patients don’t have in-person access to routine and follow-up cancer care — such as during the COVID-19 pandemic — it is important to recognize the gaps that exist among racial and ethnic minorities,” lead study author Cardinale B. Smith, MD, PhD, associate professor of medicine and the chief quality officer for cancer services at Mount Sinai Health System, said in a press release.² “We know that many patients have not been seeking medical attention or continuing routine care because of fear about the virus.”

Included in the analysis was a National Cancer Institute (NCI) designated cancer center and 8 ambulatory sites across New York City. Data was collected on all patients with cancer with an in-person or telehealth visit during the peak of the pandemic from March 1, 2020 to June 1, 2020 using the electronic health record. Of note, telehealth included both video visits and telephone encounters for the purpose of this study.

There were a total of 7681 telehealth visits across the peak of the pandemic, 76% of which were video visits. The mean age of the patients included in the study was 65 years of age.

Among patients who utilized video visits, 50% were white, 17% were black, 8% were Asian, and 5% were Hispanic. Moreover, of those who utilized phone encounters, 43% were white, 23% were Black, 7% were Hispanic, and 6% were Asian.

Comparatively, of all patients seen at the health system in 2019, 42% were white, 23% were black, 14% were Hispanic, and 7% were Asian. Additionally, less than 1% of all patients used telehealth in 2019.

Overall, researchers observed significantly less utilization of video visits (P = .003), phone visits (P = .02), and telehealth as a whole (P = .02) by minority patients. Importantly though, this study was limited to 1 health system, thus additional research is still necessary to determine whether these results are generalizable beyond the population studied.

“Telehealth utilization really increased exponentially as a way to be able to provide care to patients even when we couldn’t be in person, but were able to provide care via telehealth,” Smith said in a presentation of the data. “What we witnessed was a significantly decreased amount of video visit utilization, particularly among minority communities, and the awareness of these disparities is really critically important, especially as COVID-19 is making its impact among other cities.”

Currently, the investigators are now exploring ways to improve patient access to telehealth and have already obtained a grant which will allow them to provide in-home remote monitoring of patients. Patients who are enrolled in the study will be provided with a Wi-Fi booster or enabler and a tablet so they can have video visits with their clinician and participate in patient reported outcome measures.

References:

1. Smith CB, Bhardwaj AS. Disparities in the use of telehealth during the COVID-19 pandemic. Presented at: 2020 ASCO Quality Care Symposium. Abstract #: 87.

2. Black and Hispanic Patients With Cancer Used Telehealth Care Less Often Than White Patients During COVID-19 Pandemic [news release]. Alexandria, Virginia. Published October 5, 2020. Accessed October 12, 2020. https://www.asco.org/about-asco/press-center/news-releases/black-and-hispanic-patients-cancer-used-telehealth-care-less?cid=DM6113&bid=59026103