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Pediatric, Urgent Care Telemedicine During COVID-19: A Comparative Analysis
Patricia Solo-Josephson1,2,3, Joanne Murren-Boezem1,2,3, Cynthia M Zettler-Greeley1
1Center for Health Delivery Innovation, Nemours Children's Hospital, Orlando, Florida, USA.
Insights
Telemedicine improved access for diverse patients during the COVID-19 pandemic, increasing language options and use among those with subsidized insurance. However, rural patient telemedicine use declined, highlighting areas for continued focus on health equity.
Area of Science:
- Health Services Research
- Digital Health Equity
- Pediatric Healthcare
Background:
- Telemedicine offers potential to enhance healthcare access, but its realized impact on patient diversity and health equity requires ongoing evaluation.
- The COVID-19 pandemic accelerated telemedicine adoption, necessitating an understanding of its long-term effects on healthcare accessibility for varied populations.
Purpose of the Study:
- To assess telemedicine utilization trends in a pediatric healthcare system during the second year of the COVID-19 pandemic.
- To determine if patient diversity in telemedicine services was maintained compared to pre-pandemic and early pandemic periods.
- To identify opportunities for supporting health equity through continued telemedicine services.
Main Methods:
- Retrospective analysis of parent-initiated, urgent care telemedicine visits between June 2020 and July 2021.
- Comparison of patient demographics (race, ethnicity, age, sex, preferred language, insurance type, location) with 2019 baseline and early pandemic data.
- Statistical analysis to evaluate changes in utilization patterns across different patient subgroups.
Main Results:
- Patient demographics regarding race, ethnicity, age, and sex remained consistent with prior periods (p > 0.05).
- The number of preferred languages increased significantly (from 5 to 13), indicating broader linguistic accessibility.
- Telemedicine use increased among patients with government-subsidized insurance (p < 0.05), but declined among rural patients (p < 0.05).
Conclusions:
- Telemedicine in pediatric urgent care now serves a demographically diverse patient population, reflecting increased accessibility compared to pre-pandemic levels.
- Sustaining pandemic-era mitigation strategies, including regulatory flexibility, technological support, and translation services, is crucial for equitable virtual care access.
- Continued efforts are needed to address disparities, such as the decline in rural patient telemedicine utilization, to fully realize telemedicine's potential for health equity.
Abstract:
Telemedicine holds potential for improving access to care, but to what extent has it been realized? We examined telemedicine utilization within a pediatric health care system into the second year of the COVID-19 pandemic to illuminate maintenance of changes in patient diversity previously observed and to elucidate ongoing opportunities to support health equity. This IRB-approved study is a retrospective analysis of completed visits for parent-initiated, urgent care telemedicine services received by a pediatric health care system between June 2020 and July 2021. Unique patient characteristics were compared with those from 2019 (baseline) and early pandemic. Current study patients (n = 9,064) did not differ from patients in either prior time point (n = 5,462) in race, ethnicity, age, or sex (ps > 0.05). Thirteen preferred languages spoken, relative to 5 at the 2019 baseline. Telemedicine was utilized significantly more than baseline among patients accessing government-subsidized health insurance (p < 0.05); utilization among rural patients (1.2%) declined relative to baseline (p < 0.05). This research examined demographic changes among patients utilizing urgent care telemedicine throughout the COVID-19 pandemic and illuminated the importance of sustaining the virtual care needs of a more diverse patient population. Unlocking telemedicine's potential has implications for improving health equity. Our research demonstrates that patients seeking virtual care in the "new normal" represent a greater demographic diversity than observed prepandemic. Mitigation strategies used during the pandemic to engage and support a diverse patient population, including regulatory waivers, technological outreach, and translation services, must continue in support of equitable access for all.
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