Characteristics of Patients Accessing Outpatient Oncology Services Virtually and Predictors of Subsequent Unplanned Emergency Department Presentations in 78,323 Adults in Australia: Retrospective Cohort Study

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: The study aims to identify sociodemographic and clinical predictors of virtual care use among patients accessing outpatient oncology services and quantify their 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 1-year follow-up. Virtual care use and unplanned ED visits were categorized as none, low (1-3), or high (≥4), and analyzed using modified Poisson models with robust variance estimation, adjusted for sociodemographic and clinical factors. Results: Out of 78,323 patients, 37,706 (48.1%) 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 (vs urban) residence (relative risk [RR] 1.23, 95% CI 1.19‐1.28), mental health disorders (vs none; RR 1.28, 95% CI 1.24‐1.33), Charlson comorbidities (vs none; RR 1.12, 95% CI 1.09‐1.28), and receiving care during the COVID-19 pandemic (vs nonpandemic period; RR 3.03, 95% CI 2.92‐3.15). In contrast, older age (≥75 y vs 18‐44 y; RR 0.78, 95% CI 0.74‐0.83) and being born overseas (vs Australia; RR 0.83, 95% CI 0.80‐0.86) were associated with lower virtual care use. High virtual care use (vs none) was associated with an increased risk of ≥4 unplanned ED visits (RR 2.64, 95% CI 2.52‐2.79). Conclusions: The use of virtual outpatient oncology services varied based on patients’ demographic and clinical characteristics. Higher virtual outpatient use was associated with increased unplanned ED presentations. Further research using causal analytic approaches is needed to clarify the relationship between virtual care and unplanned acute care use.