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Trends in telemedicine visits among pediatric asthma patients during COVID-19
Kaitlin Hall1, Dariush Kafashzadeh1, Lucia Chen2
1Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Calif.
Insights
Pediatric telemedicine use for asthma surged during the COVID-19 pandemic, benefiting medically complex children. However, Black children had lower access, indicating ongoing disparities in telemedicine for asthma care.
Area of Science:
- Pediatric Asthma Care
- Health Equity
- Telemedicine Utilization
Background:
- Environmental and social factors create asthma outcome inequities for marginalized children.
- Telemedicine adoption accelerated during COVID-19, offering potential to improve pediatric asthma care access.
Purpose of the Study:
- To characterize pediatric telemedicine users with asthma.
- To analyze asthma telemedicine use trends during the COVID-19 pandemic.
Main Methods:
- Retrospective analysis of electronic health records for pediatric asthma patients (0-17 years).
- Data collected from March 2019 to March 2022 at UCLA Medical Center.
- Examined user characteristics, usage trends, and factors associated with telemedicine visits.
Main Results:
- Telemedicine visits for asthma peaked at 74.3% early in the pandemic, decreasing to 13.6% by 2022.
- Black patients had lower odds of telemedicine use (OR 0.49) compared to White patients.
- Patients with public insurance, severe persistent asthma, or comorbidities showed higher odds of telemedicine use.
Conclusions:
- Pediatric asthma telemedicine use increased post-pandemic, especially for medically complex patients.
- Outcomes, including emergency visits and hospitalizations, were similar between telemedicine users and non-users.
- Disparities persist, with Black patients at the institution exhibiting lower telemedicine utilization rates.
Background:
Environmental and social factors, including lack of access to asthma care, contribute to persistent inequities in asthma outcomes among children from historically marginalized ethnoracial groups. Telemedicine, which expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, may be an approach to augment access to pediatric asthma care.
Objectives:
We sought to describe characteristics of pediatric (0-17 years) telemedicine users with asthma and characterize use trends throughout the COVID-19 pandemic.
Methods:
We conducted a retrospective analysis using electronic health record data of pediatric patients with asthma seen at University of California, Los Angeles, Medical Center between March 2019 to March 2022 describing telemedicine user characteristics, trends of asthma-related telemedicine use, and associations between user characteristics and having a telemedicine visit.
Results:
Among 6,777 patients with asthma, the percentage of asthma-related telemedicine visits peaked early in the pandemic, comprising 74.3% of visits, before decreasing to 13.6% in 2022. Compared to White patients, Black patients had lower odds of an asthma telemedicine visit (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.26, 0.94). Those with public insurance (OR, 1.7; 95% CI, 1.19, 2.43), severe persistent asthma (OR, 3.03; 95% CI, 1.70, 5.42), or comorbidities (OR, 1.59; 95% CI, 1.08, 2.33) had higher odds. Time to first emergency department visit and hospitalization comparing those with at least one telemedicine visit to those with none were similar.
Conclusions:
More pediatric asthma patients are using telemedicine since the COVID-19 pandemic, particularly those with medical complexity and comorbidities, and outcomes appear similar. However, Black patients at our institution have lower odds of using telemedicine.
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