Abstract
BackgroundData regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking.ObjectiveThe aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality.MethodsCross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses.ResultsSurvey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing.ConclusionsTelehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.
Highlights
With the rapid shift to video visits during the COVID-19 pandemic, adolescents, who are typically digital natives, have been key consumers of technology-delivered health care [1]
Prior to COVID-19, telehealth was seen as a potential tool to increase access to care and reduce health disparities for adolescents, but geographic restrictions and limited reimbursement led to low utilization [2]
Most AYA and caregivers used a smartphone with a Wi-Fi connection for their telehealth visit
Summary
With the rapid shift to video visits during the COVID-19 pandemic, adolescents, who are typically digital natives, have been key consumers of technology-delivered health care [1]. Prior to COVID-19, telehealth was seen as a potential tool to increase access to care and reduce health disparities for adolescents, but geographic restrictions and limited reimbursement led to low utilization [2]. Even prior to the pandemic, there were limited data on the acceptability of telehealth for adolescents, and existing studies were mostly confined to mental and sexual health care [5,6,7], neglecting other areas of adolescent health care delivery, including gender-affirming care and management of eating disorders. Recent systematic reviews demonstrate acceptability of telehealth for a variety of pediatric and adult conditions and modest effect sizes for effectiveness for telemedicine management of pediatric conditions, including asthma, attention deficit hyperactivity disorder, and depression, the acceptability of video-delivered care for a broad sample of adolescent health conditions remains unknown [1,8]. Feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking
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