Decrease in Pediatric Patient Telemedicine Visits During COVID-19 Pandemic

While telemedicine is a valuable tool to provide access to care for families seeking care within a small subspecialty with a limited supply of providers, there was a significantly lower amount of new pediatric patient visits in the beginning of the COVID-19 pandemic.

There was a significantly lower amount of new pediatric patient visits during the COVID-19 pandemic, which may imply hesitancy to seek care, according to Pediatric Rheumatology.1 However, both in-office and telemedicine appointments did not interfere with patient characteristics and telemedicine continues to be a useful tool for pediatric patients, including a limited physical exam, during this time.

“It is important to understand how best to utilize telemedicine in a post-pandemic healthcare setting. With the recent expansion of telemedicine use, lessons learned on how to integrate a virtual platform into practice should be shared,” explained investigators. “This study is the first study comparing patient populations who utilized telemedicine in pediatric rheumatology during the COVID-19 pandemic to patient populations with office-visits in the prior year.”

Outpatient telehealth visits were analyzed between April and June 2020 (n = 75) and compared with in-office visits from March 2019 and March 2020 (n = 415) at West Virginia University using an independent sample t-test and Chi Square statistic. In the April through June group, no in-office visits were made during this time and patients did not have an alternative option. Patients were included in both cohorts if they had an in-office appointment during the previous year as well as a telemedicine visit during the April through June period.

Characteristics such as age, diagnosis, and zip code, which were reviewed via electronic medical records (EMR), as well as no-shows, completed visits, new patient, and follow-up status were determined.

The average age of patients in both pre-pandemic and pandemic telemedicine cohort was 11.71 years and 11.94 years in the in-office group. Additionally, mean distance, mean income, and rural designation showed no significant difference across all patients.

A significantly higher percentage of children with juvenile idiopathic arthritis (JIA) had telemedicine appointments compared with in-office visits during the previous year (29.17% vs 13.73%, respectively). However, the percentage of patients with fibromyalgia remained the same. Telemedicine appointments were significantly lower when compared with new patient in-office visits (p < 0.0001). During the first 3 months of the pandemic, 60% were new patients utilizing telemedicine, however, 84% scheduled in-office visits during the pre-pandemic year. No-show rates remained the same for both telemedicine and in-office visits (6 vs 6.7%, respectively).

While diagnostic accuracy was not compared between in-office and telemedicine visits, investigators did evaluate the utility of telemedicine during the pandemic, including physical exam, and showed that virtual appointments could successfully be used in combination with in-office visits. Only 1 board-certified pediatric rheumatologist was included in this study. Lastly, disease severity, number of labs, practicing behavior, patient satisfaction, and number of resources could not be determined.

“This is the first study to compare patient characteristics and office visit metrics in a pediatric rheumatology practice during the COVID-19 pandemic with telemedicine usage. Now that the pandemic has accelerated the use of telemedicine, further study should evaluate patient attitudes, preferences, and satisfaction. Additional study among providers should assess diagnostic error rates, resource utilization, prescribing patterns, and the patient-provider relationship,” investigators concluded. “Telemedicine is another tool in the pediatric rheumatologist toolkit to provide access to care for families seeking care within a small subspecialty with a limited supply of providers in any given geographic area.”

Reference:

Perdue A, Mullett C, Umer A, Rosen P. Utility of telemedicine in pediatric rheumatology during the COVID-19 pandemic. Pediatric Rheumatology. https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-021-00624-z. Published September 30, 2021. Accessed September 30, 2021.