Integration and Impact of Telemedicine in Underserved Pediatric Primary Care

Abstract

Telemedicine, more novel in provision of pediatric care, rapidly expanded due to the recent coronavirus disease 2019 pandemic. This study aimed to determine the feasibility of telemedicine for acute and chronic care provision in an underserved pediatric primary care center. Items assessed included patient demographic data, chief complaint, and alternative care locations if telemedicine was not available. In our setting, 62% of telemedicine visits were for acute concerns and 38% for chronic concerns. Of acute telemedicine visits, 16.5% of families would have sought care in the Emergency Department/Urgent Care, and 11.3% would have opted for no care had telemedicine not been offered. The most common chronic issues addressed were attention deficit hyperactivity disorder (80.3%) and asthma (16.9%). Racial disparities existed among our telemedicine visits with Black patients utilizing telemedicine services less frequently than non-Black patients. Telemedicine is feasible for pediatric acute and chronic care, but systems must be designed to mitigate widening racial disparities.

Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era

“…Patients and parents showed satisfaction with lifestyle changes, great enthusiasm about nutrition programs, and increased motivation [51,137]. This was reflected in increased adherence to family obesity treatment, particularly among the rural population, and in family involvement in nutrition programs [42,125].…”

“…A study undertaken by Walters et al [42] at Cincinnati Children's Hospital evidenced that, through the provision of telemedicine, children received care in the most appropriate and cost-effective way for mild acute problems, offering the right care, at the right time, in the right place [42]. The research examined telemedicine visits during five months in the pandemic period: 62% of the visits were for acute problems, such as rash, eye drainage/redness, constipation, and cough, while 38% were for chronic conditions, in particular mental health problems (including ADHD) and asthma [42]. This study found that the implementation of telemedicine into pediatric primary care was feasible even for children from underserved communities and families reported that telemedicine provided care, guaranteeing to avoid unnecessary emergency department/urgency care visits.…”

“…This study found that the implementation of telemedicine into pediatric primary care was feasible even for children from underserved communities and families reported that telemedicine provided care, guaranteeing to avoid unnecessary emergency department/urgency care visits. However, among the clinical population, Walters et al [42] saw racial disparities in the use of telemedicine; that is, Black families used telemedicine significantly less than non-Black families, as well as non-English speaking families, who did not have access to the telemedicine visits owing to Cincinnati Children Hospital technological constraints. These types of disparities are consistent with previous literature suggesting that technology can widen inequalities [32,[42][43][44].…”

“…However, among the clinical population, Walters et al [42] saw racial disparities in the use of telemedicine; that is, Black families used telemedicine significantly less than non-Black families, as well as non-English speaking families, who did not have access to the telemedicine visits owing to Cincinnati Children Hospital technological constraints. These types of disparities are consistent with previous literature suggesting that technology can widen inequalities [32,[42][43][44].…”

“…Tele-nutrition has been demonstrated over time to have good benefits in the management of obesity, assuming the child is fit and the service provided is of comparable quality to in-person care provided [42]. The effectiveness of tele-nutrition at reducing BMI and improving adherence to treatment assumes the incorporation of telemedicine into the care of pediatric patients with obesity.…”