Abstract
The COVID-19 (coronavirus disease 2019) pandemic brought rapid expansion of pediatric telehealth to maintain patient access to care while decreasing COVID-19 community spread. We designed a retrospective, serial, cross-sectional study to investigate if telehealth implementation at an academic pediatric practice led to disparities in health care access. Significant differences were found in pre-COVID-19 versus during COVID-19 patient demographics. Patients seen during COVID-19 were more likely to be younger, White/Caucasian or Asian, English speaking, and have private insurance. They were less likely to be Black/African American or Latinx and request interpreters. Age was the only significant difference in patient demographics between in-person and telehealth visits during COVID-19. A multivariate regression showed older age as a significant positive predictor of having a video visit and public insurance as a significant negative predictor. Our study demonstrates telehealth disparities based on insurance existed at our clinic as did inequities in who was seen before versus during COVID-19.
Highlights
Telehealth is a mechanism by which patients can access pediatricians via mobile device for either face-to-face or telephone visits.[1]
When the coronavirus disease 2019 (COVID19) pandemic hit the United States, pediatricians were forced to make significant changes in clinical practice starting in March 2020
Our results demonstrate that during the COVID-19 pandemic, patients who completed a medical visit of any kind were significantly more likely to be White or Asian and to have private insurance and speak English
Summary
Telehealth is a mechanism by which patients can access pediatricians via mobile device for either face-to-face or telephone visits.[1] It has been used to reach patients who experience difficulties seeing their providers in person, such as those with significant disabilities or long travel times to clinic. Telehealth was not initially widely adopted due to provider and patient technological, cultural, and financial barriers. As recently as 2016, only 12% of pediatricians worked in practices utilizing telehealth.[2] When the coronavirus disease 2019 (COVID19) pandemic hit the United States, pediatricians were forced to make significant changes in clinical practice starting in March 2020. To maintain access to care, while allowing for social distancing and mitigating community spread of COVID-19, medical providers dramatically expanded their telehealth services.[3] In addition, to ensure practitioners were adequately funded for this care, Medicare and Medicaid liberalized telehealth reimbursement policies. Studies estimated a 6-fold increase in telehealth appointments between March 2, 2020, and April 14, 2020.4
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