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Use of Telemedicine for Children in Foster Care
Kristine Fortin1, Judith Dawson1, Philip V Scribano1
1Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Telemedicine effectively reached most children in foster care during the pandemic, though in-person visits remained crucial for certain health assessments and follow-ups. This highlights telemedicine
Area of Science:
- Pediatric Health
- Telehealth Research
- Child Welfare Services
Background:
- Children in foster care have unique healthcare needs and face significant barriers to access.
- The COVID-19 pandemic necessitated rapid adoption of telemedicine, offering lessons for future applications.
- Previous telemedicine studies have not specifically focused on the foster care population.
Purpose of the Study:
- To describe telemedicine health assessments for children in foster care during the COVID-19 pandemic.
- To compare medical recommendations and outcomes between telemedicine and in-person assessments for this population.
- To identify barriers and facilitators for implementing telemedicine in this vulnerable group.
Main Methods:
- A telemedicine program was implemented at a specialty clinic for children in foster care during COVID-19 restrictions.
- Physicians rated communication and visual quality using the Telehealth Usability Questionnaire.
- Outcomes, including referrals for laboratory work, medications, and health services, were tracked and compared to in-person visits from the prior year.
Main Results:
- 91% of referred children completed telemedicine visits, with physicians rating communication favorably over visual quality.
- Telemedicine patients had higher rates of health service referrals but significantly lower rates of laboratory work completion, vision referrals, and new medication prescriptions compared to in-person visits.
- Physician-reported communication quality was high, but differences in objective health outcomes suggest limitations.
Conclusions:
- Telemedicine proved accessible for most children in foster care, demonstrating its utility in overcoming access barriers.
- The study underscores the necessity of in-person assessments for comprehensive care, particularly for laboratory work and medication management.
- Findings can inform the development of hybrid care models and advocate for improved healthcare access for underserved populations through telemedicine.
Abstract:
Telemedicine studies specific to children in foster care are needed, given unique health care needs and barriers. It is important to utilize lessons learned from telemedicine programs deployed by necessity during the COVID-19 emergency. Describe telemedicine health assessments for children in foster care performed during the COVID-19 pandemic. Compare medical recommendations resulting from telemedicine and in-person assessments. After navigating barriers specific to children in foster care including consent issues, we implemented a telemedicine program at our specialty clinic for children in foster care when in-person visits were restricted. Outcomes of telemedicine referrals were tracked. After each visit, physicians were asked to rate ability to express themselves, hear and see patients from 1 (strongly disagree) to 5 (strongly agree) using items from the validated Telehealth Usability Questionnaire. Recommendations for laboratory work, medication, and health services referrals were recorded and compared with 205 patients seen in-person the year prior. From 91 referrals, 83 (91%) children with a mean age of 9 years completed telemedicine visits. Physicians rated receptive and expressive communications more favorably than visual quality. Most telemedicine patients (77%) received a referral for health care services but had significantly lower rates of laboratory work completion, vision referrals, and prescriptions for new medications compared with 205 patients seen in-person. Results suggest that telemedicine was accessible to most patients and highlighted essential in-person components of comprehensive health assessments. Findings could inform ongoing telemedicine applications and advocacy for underserved populations.
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