Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era

Brodie, Kara D; Fakurnejad, Shayan; Czechowicz, Josephine A.; Nadaraja, Garani S.

doi:10.1016/j.ijporl.2021.110971

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…This is in the context of known decreased access to pediatric otolaryngology among these communities which has been demonstrated across the subspecialty. 10 It must be acknowledged that previous antibiotic treatment is just one variable that could be used to hypothesize regarding previous medical treatment. It is possible that some patients were in fact seen in the outpatient setting but not prescribed antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…With regards to COVID-19, its impact on access to pediatric otolaryngology care is yet to be determined, but initial studies suggest a greater emphasis on telehealth has led to reduced access to care for individuals in communities who are less served by the health care system. 10,34…”

Section: Discussionmentioning

confidence: 99%

“…Access to pediatric otolaryngology services has been demonstrated to be decreased in communities that are underserved by the health care system 9 . The impact of COVID‐19 has potentially exacerbated these inequities with greater frequency of telehealth consultations, and data suggesting longer wait times to access care and reduced rates of accessing care among Black patients, despite overall increased attendance to pediatric otolaryngology appointments 10 …”

Section: Introductionmentioning

confidence: 99%

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Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

Nicotera,

Islam,

Liu

et al. 2023

The Laryngoscope

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ObjectivesDifferences in management and outcomes of otolaryngologic diseases may reflect inequities driven by social determinants of health. This study aimed to investigate disparities in presentation and outcomes of retropharyngeal abscess (RPA) among 231 pediatric patients.MethodsMedical records were searched for pediatric patients with RPA from 2010 to 2021. Charts were reviewed for demographics, clinical features, and treatment decisions. Area deprivation index (ADI) scores for patient zip codes were determined. Chi‐square analysis independent samples t‐test, and regression analyses were used to investigate associations between variables.ResultsAmong patients presenting for RPA, Black patients were less likely to undergo surgical management than non‐Black patients (53.2% vs. 71.6%, p = 0.009). Black patients had a lower rate of treatment with antibiotics prior to hospital admission (19.4% vs. 54.4%, p < 0.001). Among patients who received surgery, Black patients had higher cross‐sectional abscess area on CT (6.4 ± 8.4 cm2 > vs. 3.8 ± 3.3 cm2, p = 0.014), longer length of stay (5.4 ± 3.3 days vs. 3.2 ± 1.5, p < 0.001), and longer time between admission and surgery (2.3 ± 2.1 vs. 0.83 ± 1.1, p < 0.001). Increased ADI was correlated with increased rate of trismus.ConclusionsLower rates of pre‐admission antibiotics and larger abscess area on CT imaging among Black patients may suggest disparities in access to primary care, resulting in presentation to tertiary care at later stages of disease and higher rates of medical management trial prior to surgical intervention.Level of EvidenceThree (retrospective cohort study) Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

Nicotera,

Islam,

Liu

et al. 2023

The Laryngoscope

View full text Add to dashboard Cite

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“… 5 , 6 Studies have identified that Black and Hispanic race, public insurance, low income, and older age are associated with lower utilization of telehealth. 7 , 8 Telehealth in otolaryngology has been successfully implemented using advanced technology for various purposes, including remote otoscopy, 9 , 10 , 11 peri‐operative visits, 12 , 13 , 14 diagnosis of peritonsillar abscess, 15 and voice evaluations. 16 However, there is limited literature on how telephone audio visits, one type of telehealth, function and are applied in OHNS, specifically in the care of marginalized patients for whom telehealth video visits may not be an option.…”

Section: Introductionmentioning

confidence: 99%

“…And yet, some have voiced concerns that health disparities persist in telemedicine care because socially disadvantaged patients may lack the technical equipment and knowledge required to participate in video visits 5,6 . Studies have identified that Black and Hispanic race, public insurance, low income, and older age are associated with lower utilization of telehealth 7,8 . Telehealth in otolaryngology has been successfully implemented using advanced technology for various purposes, including remote otoscopy, 9–11 peri‐operative visits, 12–14 diagnosis of peritonsillar abscess, 15 and voice evaluations 16 .…”

Section: Introductionmentioning

confidence: 99%

Utility of telephone visits at an urban safety‐net hospital during 2020: A retrospective review

Kim

Kidane

Brodie

et al. 2022

Laryngoscope Investig Oto

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Objective During COVID‐19, otolaryngology clinics rapidly implemented telehealth programs in accordance with social distancing guidelines and institutional policies. Our objectives are to evaluate the usefulness of telephone audio visits for underserved patients seeking otolaryngological care at an urban safety‐net hospital and identify patient factors associated with telephone visit attendance. Methods In a retrospective review of all adult telephone visits in 2020, we compared the demographics and visit characteristics of patients who attended telehealth versus in‐person visits and patients who attended versus missed telehealth visits. Univariable and multivariable regressions were utilized to identify predictors of missing telehealth visits. Results We identified 318 telehealth encounters completed by 254 patients (72.8% were of racial/ethnic minority; 76.3% had low‐income, need‐based insurances; 43.7% had limited English proficiency). The most common chief complaints were related to head and neck oncology ( n = 85, 26.7%), otology/neurotology ( n = 74, 23.3%), and general otolaryngology ( n = 69, 21.7%). The following actions were executed during telephone visits: behavioral and/or medication patient education ( n = 152, 47.8%); sharing testing/imaging/tumor board results ( n = 125, 39.3%); referrals to another department ( n = 103, 32.4%); rendering a new diagnosis ( n = 98, 30.8%); changing medications ( n = 60, 18.9%). Less than half of telephone visits (46.2%) resulted in in‐person follow‐up, most commonly for in‐person exams. The distribution of race/ethnicity differed between attended in‐person appointments versus telephone visits ( p = .01), but race and ethnicity were not significant predictors of telephone visit attendance. Conclusion Despite limited diagnostic capabilities, telephone audio visits can be an effective and accessible tool for providing continuity and advancing care in socially disadvantaged patients. Level of evidence IV.

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Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology

Allred,

Nakamura,

Mull

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveFamilies preferring to receive care in a language‐other‐than‐English have disparities in access to care. We studied the effect of implementing an ambulatory outbound scheduling team on the timeliness of scheduling referrals to pediatric otolaryngology. We hypothesized this intervention could increase access to care.Study DesignRetrospective cohort analysis.SettingTertiary care academic center.MethodsData were abstracted from the hospital's enterprise database for patients referred to Otolaryngology over 3 years (October 2019‐August 2022; 7675 referrals). An outbound scheduling team was created April 2021 and tasked with calling out to schedule referrals within one business day of receipt. Referral lag was compared across patient cohorts before and after the scheduling intervention. Log‐transformed linear regression models were used to assess the impact of the scheduling intervention on referral lag for language cohorts.ResultsThe median preintervention referral lag was 6 days (interquartile range [IQR] 2‐18), which was reduced to 1 day postintervention (IQR 0‐5; P < .001). Preintervention language‐other‐than‐English families had a median referral lag of 8 days (IQR 2‐23), which was 1.27 times higher than for patients speaking English (P < .001). With implementation of the scheduling intervention, language‐other‐than‐English families were scheduled in a median of 1 day (IQR 0‐6), and the disparity in timeliness of scheduling was eliminated (P = .131). Postintervention, referral lag was reduced by 58% in the English and 64% in the language other than English cohorts.ConclusionImplementation of an outbound ambulatory scheduling process reduces referral lag for all patients and eliminated a disparity in referral lag for language‐other‐than‐English families.

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Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era

Cited by 7 publications

References 14 publications

Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

Utility of telephone visits at an urban safety‐net hospital during 2020: A retrospective review

Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology

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