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Telehealth Reduces Missed Appointments in Pediatric Patients with Tuberculosis Infection
Angela Zhao1, Nirali Butala2, Casey Morgan Luc3
1Yale University, New Haven, CT 06510, USA.
Insights
Pediatric latent tuberculosis infection (LTBI) patients face challenges completing therapy. Telehealth significantly reduced missed appointments, improving adherence for children with LTBI.
Area of Science:
- Pediatric infectious diseases
- Public health
- Telemedicine
Background:
- Pediatric latent tuberculosis infection (LTBI) requires consistent treatment to prevent progression to active disease.
- Missed appointments and poor adherence are significant barriers to effective LTBI management in children.
- The COVID-19 pandemic necessitated adaptations in healthcare delivery, including the adoption of telehealth.
Purpose of the Study:
- To identify factors contributing to missed appointments and treatment non-completion in pediatric LTBI patients.
- To evaluate the impact of telehealth on appointment adherence during the COVID-19 pandemic.
Main Methods:
- Retrospective chart review of 129 pediatric LTBI patients (2016-2019) to analyze demographic and clinical factors associated with missed appointments and treatment failure.
- Analysis of a second cohort of 29 patients (2021) receiving telehealth follow-up appointments.
- Univariate and bivariate chi-square tests were used for statistical analysis.
Main Results:
- Language barriers, lack of a primary provider, and distance to the clinic were key factors associated with missed appointments and poor adherence.
- A significant association was found between the number of missed appointments and failure to complete treatment (p = 0.050).
- In 2021, 54% of follow-up visits were via telehealth, and the clinic's missed appointment rate decreased from 16.9% to 5.8% (p = 0.037).
Conclusions:
- Telehealth is a well-accepted modality for pediatric LTBI follow-up care.
- Implementing telehealth services can significantly improve appointment adherence and potentially treatment completion rates in pediatric LTBI management.
- Addressing social determinants of health, such as language and access to primary care, remains crucial for optimizing LTBI treatment outcomes.
Abstract:
Pediatric patients with untreated tuberculosis infection (TBI), also called latent TBI, are at risk of progression to active TB disease. The primary aim of this study was to identify factors associated with higher rates of missed appointments and failure to complete therapy for pediatric patients with TBI. A secondary aim was to determine the impact of the COVID-19 pandemic and the rise of telehealth on TBI missed appointment rates. We first performed a retrospective chart review of 129 pediatric patients referred to the free Yale Pediatric Winchester Chest Tuberculosis Clinic from 2016-2019. Associations between demographic/clinical variables and missed appointments/failure to complete therapy were analyzed using univariate and bivariate chi-square tests. Language, lack of primary provider, and distance to clinic were the main contributors to missed appointments and poor treatment adherence. There was an association between the number of missed appointments and failure to complete treatment (p = 0.050). A second cohort of 29 patients was analyzed from January-December 2021 when telehealth was offered for follow-up appointments. Of these follow-up visits, 54% were conducted via telehealth, and the clinic's missed appointment rate dropped significantly from 16.9% to 5.8% during this time frame (p = 0.037). These data demonstrate that telehealth is accepted as an alternative by patients for follow-up TBI visits.
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