Assessment of Equitable Use of Virtual Care in Pediatric Specialized Care

Objective: Telemedicine and broadly, virtual care are established modes of health care delivery but may present unintended barriers to access. We assessed postpandemic ambulatory care provision to determine whether marginalized areas were underrepresented among virtual visits. Methods: We retrospectively analyzed 396,624 ambulatory visits (January 2022 through December 2023), using patient demographics and the Ontario Marginalization Index to compare virtual (78% electronic health record-integrated video) and in-person visits across the domains of residential instability, material deprivation, dependency, and ethnic concentration. Logistic regression was used to compare virtual to in-person visits, adjusting for age, sex, and geographic location. Results: We found higher virtual care utilization for children in remote areas (41% [OR: 1.72 {1.66-1.78}]) and progressively higher virtual care utilization across age groups. Virtual care use for children aged 1-12 was 27% (OR: 1.57 [1.53-1.62]); for adolescents aged 12-16 was 33% (OR: 2.02 [1.96-2.09]); and for those over 16 years was 38% (OR: 2.56 [2.49-2.64]), compared to infants (19%). Indices of residential instability, dependency, and material deprivation had minimal impact on access to virtual care; however, areas with high ethnic concentrations had significantly fewer virtual visits compared to the least ethnically concentrated areas (26.1% vs. 35.0%; adjusted OR: 0.65 [0.63-0.67]). Each quintile increase in marginalization within the ethnic concentration index was associated with an 11% decrease in the odds of a virtual visit. Conclusions: Virtual care use was higher for those at greater distance but lower in ethnically concentrated areas. Further investigation of strategies targeting language barriers, technological literacy, and cultural beliefs is warranted.