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

Abstract

Objective: The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. Methods: Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020–February 2021) with the same period before the pandemic (March 2019–February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). Results: We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. Conclusions: Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019–2022)

“…12 Our finding that pediatric primary care patients declined from 2019 to 2022 is disturbing, yet consistent with studies assessing the impact of the pandemic on the continuity of pediatric care through 2020. [13][14][15][16] This is particularly concerning as our study includes safety-net populations who were already experiencing a disproportionate burden of health inequities before the pandemic. Though our report did not stratify pediatric care trends by demographic subgroups of interest (eg, race, ethnicity, insurance, state) or by in-person versus telehealth, other studies suggest that minority and low-income children were less likely to receive telehealth care and less likely to resume care after COVID-19 disruptions.…”

Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program

“…There are 27 locations associated with the hospital system, including those that offer primary care, specialty care, and emergency services. The health system accepts both private and public insurance, including Medicaid, and serves a diverse patient population (eg, approximately 53% White, 24% Black, 12% Hispanic, 2% multiracial; 48% female; see Phan et al 31 for more information on sociodemographic characteristics of patients served by this health system). For each referral order placed during this period, manual review of the EHR was conducted to ensure data quality (eg, removing duplicate or cancelled referral orders) and record information on patient attendance at subsequent evaluation visits with medical, psychological, occupational therapy, and/or physical therapy providers within the interdisciplinary chronic pain program.…”