Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

Abstract

Objectives: Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OV) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. Methods: We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center April 2019-December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. Results: Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine vs. OV (46 (IQR 35-72) vs. 62 (IQR 51-80) minutes; P<0.001) with no significant difference in time spent with provider (28 (IQR 21-41) vs. OV 30 (IQR 24-39) minutes; P=0.08). Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 (P<0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office (P<0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine (P=0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs. audio-only; P=0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits (P<0.05 for all comparisons). Conclusions: Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.