Patterns of telehealth utilization during the COVID-19 pandemic and preferences for postpandemic telehealth use: A national survey of oncology clinicians

Background: Rarely used in routine practice pre-pandemic, telehealth utilization for cancer care rose significantly during the COVID-19 pandemic. Increased familiarity with telehealth has led to calls to continue its use after the pandemic ends. Yet national patterns of oncology telehealth utilization by visit type, preferences for telehealth use post-pandemic and barriers to telehealth for patients with cancer have not been described. Methods: 9,336 survey invitations were emailed to US-based ASCO members who have agreed to receive communications. Survey distribution was equally divided over five US regions, and practice type (e.g., academic, community) was reflective of ASCO membership proportions. The survey was open and data collected from January 4-28, 2021. Non-respondents received two reminder emails at week intervals. Analysis is descriptive. Results: 200 respondents completed the survey (2%). Respondents were 72% medical oncologists, 66% urban, 64% academic-affiliated, and from 42 states. 99% currently offered telehealth. 63% used telehealth for <=30% of all patient visits in the last 30 days;18% used telehealth for more than half of visits. Telehealth utilization varied by visit type (table). 64% reported that the care delivered in telehealth visits was similar quality to in-person visits (29% worse). Assuming no regulatory or financial barriers to telehealth use after the pandemic, 92% would like to use telehealth for at least some visit types;only 8% prefer not to use telehealth. 20% would like to use telehealth for all visits types, and 64%, 54%, 33% and 17% would like to use telehealth for survivorship, symptom management, evaluation of patients receiving treatment and new patient visits, respectively (multiple selections allowed). Major barriers to telehealth were lack of patient access to technology (reported by 81%), limited patient technological proficiency (80%), language barriers (45%), uncertainty about future reimbursement (41%) and lack of administrative resources to support clinicians (33%). 68% agreed that the barriers increase cancer care disparities. Conclusions: Telehealth utilization was widespread during the COVID pandemic and varied by visit type. Most respondents plan to use telehealth in the future, but report barriers to continued use that worsen disparities.

Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services.

BACKGROUND: The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. METHODS: This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. RESULTS: Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. CONCLUSION: Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.

ANTECEDENTES: La pandemia en curso tiene un efecto colateral sobre la salud en la prestación de atención quirúrgica a millones de pacientes. Se sabe muy poco sobre el manejo de la pandemia y sus efectos colaterales en otros servicios, incluida la prestación de servicios quirúrgicos. MÉTODOS: Se ha realizado una revisión de alcance de toda la literatura disponible relacionada con COVID-19 y cirugía utilizando bases de datos electrónicas, páginas web de sociedades, seminarios online y repositorios de pre-publicaciones. RESULTADOS: Se han publicado varias guías perioperatorias en un corto período de tiempo. Muchas recomendaciones son contradictorias y, en el mejor de los casos, se basan en datos anecdóticos. A medida que las regiones con el mayor volumen de operaciones per cápita se ven afectadas, se cancela o difiere un número sin precedentes de operaciones. Ninguna de las principales partes interesadas parece haber considerado cómo una pandemia priva de recursos a los pacientes que necesitan una intervención quirúrgica, con pacientes afectados de manera desproporcionada debido a la naturaleza del tratamiento (uso de anestesia, quirófanos, equipo de protección, contacto físico y necesidad de atención perioperatoria). No existen recomendaciones sobre cómo reanudar la actividad quirúrgica. La evaluación tras la pandemia y la planificación futura deben incluir a los servicios quirúrgicos como una parte esencial para mantener la atención quirúrgica adecuada para la población también durante un brote epidémico. La prestación de servicios quirúrgicos, debido a su naturaleza transversal y a sus efectos sinérgicos en los sistemas de salud en general, debe incorporarse a la agenda de la OMS para la planificación nacional de la salud. CONCLUSIÓN: Los pacientes se ven privados de acceso a la cirugía con una pérdida de función incierta y riesgo de un pronóstico adverso como efecto colateral de la pandemia. Los servicios quirúrgicos necesitan un plan de contingencia para mantener la atención quirúrgica durante la pandemia y en la fase post-pandemia.