Gynecologic Oncology Patients in Rural Areas Less Likely to Utilize Telemedicine During the COVID-19 Pandemic

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has resulted in shifts in clinical care delivery to incorporate more telemedicine services. However, there are concerns regarding limitations of its use with regard to access to and ability to use requisite technology. The purpose of this study was to characterize gynecologic oncology patients who utilized telemedicine in their cancer care in order to determine potential barriers to telemedicine use. METHODS: A single institution retrospective chart review of patients who participated in a telemedicine visit from March 1, 2020 to September 30, 2020 at a National Cancer Institute-designated cancer center was completed. institutional review board approval was obtained for the study. Demographic factors were compared between telemedicine users and nonusers using Fisher's exact test for categorical values and Wilcoxon rank sum test for continuous variables. RESULTS: Out of 2,238 patients, 193 patients participated in telemedicine visits. There were no significant differences in age, race, primary language, or insurance status. 8.9% of patients with private insurance or Medicaid/Medicare utilized telehealth services, compared to 4.1% of all other patients (P=.0462). The odds of using telemedicine for patients in rural zip codes was 34.6% less than for patients in nonrural zip codes (Odds Ratio 0.654, 95% CI 0.473-0.906). CONCLUSION: Telemedicine provides an opportunity to reduce unnecessary patient exposure to healthcare settings and patient financial burden. While 37% of patients seen lived in rural areas, a significantly smaller proportion of telemedicine users lived in rural areas, compared to nonusers (P=.0101). This highlights the importance of identifying barriers to utilizing telemedicine services and developing strategies to improve access.