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COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use
Ayanda Chakawa1,2, Leslee Throckmorton Belzer1,2,3, Trista Perez-Crawford1,2
1Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
Insights
Telehealth use in pediatric integrated primary care during COVID-19 showed lower attendance and increased internalizing concerns. Disparities were observed, with Black children less likely to be scheduled for telehealth compared to White children.
Area of Science:
- Pediatric mental health
- Telehealth utilization
- Healthcare disparities
Background:
- The COVID-19 pandemic heightened pediatric mental health needs, particularly for minority and underserved populations.
- Increased reliance on telehealth in integrated primary care (IPC) occurred due to COVID-19 protocols.
- Limited understanding exists regarding pediatric telehealth IPC utilization among diverse groups during the pandemic.
Purpose of the Study:
- To compare in-person versus telehealth IPC consultation utilization in children aged 1-19.
- To examine associations between service delivery modality and attendance, referral concerns, and sociodemographic factors.
- To identify potential disparities in pediatric telehealth access and outcomes.
Main Methods:
- A comparative study analyzed data from pre-COVID-19 (in-person) and mid-COVID-19 (telehealth) periods.
- Logistic regression modeling was employed to assess relationships between service modality and key variables.
- Data included consultation attendance, referral concerns, and race/ethnicity for children in an inner-city clinic.
Main Results:
- Telehealth service delivery was significantly associated with non-attendance.
- Children with internalizing problems were more likely to be scheduled for telehealth than those with externalizing problems.
- Black children had lower odds of being scheduled for telehealth compared to White children.
Conclusions:
- While telehealth facilitated IPC continuity during COVID-19, preliminary data indicate reduced attendance and increased internalizing concerns.
- Disparities in telehealth scheduling for Black patients were identified, warranting attention.
- Urgent monitoring and interventions are needed to address emerging telehealth and COVID-19-related behavioral health disparities.
Objective:
The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups.
Methods:
A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1-19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables.
Results:
Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children.
Conclusion:
Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.
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