JMIR Publications

ABSTRACT

Background:

Virtual care has become increasingly integrated into oncology services since the COVID-19 pandemic, yet little is known about which patients use it most and how its use is associated with unplanned emergency care among people living with cancer.

Objective:

To identify sociodemographic and clinical predictors of virtual care use among patients accessing outpatient oncology services, and to quantify its association with unplanned emergency department (ED) visits.

Methods:

A retrospective cohort study was conducted using linked administrative health data for 78,323 adults with cancer who accessed outpatient oncology services in Victoria and Queensland, Australia, between January 2018 and December 2020, with a one-year follow-up. Virtual care use and unplanned ED visits were categorised as none, low (1–3), or high (≥4) and analysed using multinomial logistic regression adjusted for sociodemographic and clinical factors.

Results:

37,706 (48.1%) patients did not use virtual care (only in-person); 24,196 (30.9%) had low use; and 16,421 (20.9%) were high users. Higher virtual care use was associated with rural residence (OR 1.20; 1.15–1.26), mental health disorders (OR 1.59; 1.50–1.68), comorbidity burden (OR 1.15; 1.09–1.21), and receiving care during the COVID-19 pandemic (OR 5.50; 5.10–5.91). In contrast, older age (≥75 vs 18–44 years: OR 0.67; 95% CI 0.61–0.73) and being born overseas (OR 0.89; 95% CI 0.85–0.94) were associated with lower virtual use. High virtual care users had increased odds of ≥4 unplanned ED visits (OR 2.51; 2.15–2.90).

Conclusions:

Virtual care use varied by patient characteristics and was associated with increased unplanned ED visits, potentially reflecting greater health complexity or cautious referral practices. Understanding the drivers of virtual care use and its impact on acute care is essential to inform more effective, equitable service delivery Clinical Trial: NA