COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

Abstract

Objective The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups. Methods A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables. Results Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children. Conclusion Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.

Widening Racial Disparities During COVID-19 Telemedicine Transition: A Study of Child Mental Health Services at Two Large Children’s Hospitals

“…Although implementation of telemedicine holds much promise for greater accessibility of mental health services, our findings demonstrate that the transition to telemedicine in 2020 at both CHOP and BCH reflects what many other academic centers 6 , 7 , 8 , 9 , 10 have found: an exacerbation of racial disparities in overall service utilization. In 2020, clinicians at both CHOP and BCH appears to have seen fewer racially minoritized patients and more white-identifying patients compared to the same period in 2019, albeit the findings emerged at different time points (CHOP within one month and BCH within six months – also acknowledging that findings may have been apparent at one month, but this study may not have been adequately powered to detect such differences at one-month).…”

“…Another study determined that in pediatric primary care, significant racial disparities existed in telemedicine services – among emergency and chronic visits – following the transition to telemedicine 9 . A recent study from a pediatric integrative primary care practice, that included mental health services, found that Black children were 35% less likely to be scheduled for telemedicine appointments when compared to their white counterparts 10 .…”

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic

“…Our data set lacked an indicator for telehealth visits, precluding the assessment of telehealth access as a contributor to care disparities, as previously reported. 19 Finally, Packard Children's Health Alliance represents one health care system; our findings require replication in other health care systems to assess their generalizability.…”

Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic

“…These disparities were similar to disparities seen in other pediatric and adult studies. [1][2][3][4][21][22][23][24][25][26] Black and Hispanic populations in the United States have faced a long history of systemic racism, originating from foundations in slavery. Structural racism has also permeated the health care system, ranging from mistreatment of Black populations in medical research to racial segregation of hospitals.…”