Social Determinants of Pediatric Primary Care Telehealth and In-Office Visits During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic.

IF 3 3区 医学 Q1 PEDIATRICS
Jordee M Wells, Tyler Gorham, Skyler E Kalady, Deena J Chisolm
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引用次数: 0

Abstract

Objective: To describe the use of primary care telehealth following the rapid reduction of in-person pediatric primary care availability during the severe acute respiratory syndrome coronavirus 2 pandemic and how this varied by community-level social determinants and individual-level social needs.

Methods: We conducted a retrospective cohort study of children 0 to 17 years across 16 sites within Nationwide Children's Hospital Primary Care Network from March 22 to July 31, 2020, and a preceding comparator period (2019). The study population includes 107,629 patient encounters. We compared visit type (in-person vs telehealth), demographics, presence of individual social needs, and community social determinants using the Child Opportunity Index 2.0 (COI). To assess telehealth utilization, we compared the ratio of 2019 to 2020 primary care visits across levels of COI. We trained a linear regression model predicting the number of telehealth encounters in 2020 using individual patient characteristics and COI.

Results: Patients in census tracts with high and very high levels of opportunity maintained the highest relative encounter volume (2020:2019) at the beginning of the pandemic (0.78 and 0.73, respectively, compared to 65% for children living in very low opportunity neighborhoods; P < 0.001). Patients with caregiver-reported social needs (housing, transportation, utilities, food) had relatively greater telehealth use following the start of the public health emergency.

Conclusions: Volume of primary care visits decreased least for high and very high-opportunity neighborhoods yet individual social needs were associated with higher relative use of telemedicine. Findings suggest that telehealth was an important modality to deliver care to children with social needs but does not overcome community-level barriers.

SARS-CoV-2 大流行期间儿科初级保健远程保健和诊室就诊的社会决定因素。
目的描述在 SARS-CoV-2 大流行期间,儿科初级保健上门服务迅速减少后初级保健远程医疗的使用情况,以及社区层面的社会决定因素和个人层面的社会需求有何不同:我们在 2020 年 3 月 22 日至 7 月 31 日以及之前的参照期(2019 年)对全美儿童医院初级保健网络内 16 个站点的 0-17 岁儿童进行了一项回顾性队列研究。研究对象包括 107629 次就诊。我们使用儿童机会指数 2.0 (COI),比较了就诊类型(亲诊与远程医疗)、人口统计学、个人社会需求的存在以及社区社会决定因素。为了评估远程医疗的使用情况,我们比较了不同 COI 水平的 2019 年与 2020 年初级保健就诊率。我们利用患者个人特征和 COI 建立了一个线性回归模型,预测 2020 年远程医疗就诊次数:结果:在大流行开始时,机会度高和机会度非常高的人口普查区的患者保持了最高的相对就诊量(2020 年:2019 年)(分别为 0.78 和 0.73,而机会度非常低的社区儿童的就诊量为 65%;P 结论:在大流行开始时,机会度高和机会度非常高的人口普查区的患者保持了最高的相对就诊量(2020 年:2019 年):机会多和机会少的社区初级保健就诊量减少最少,但个人社会需求与远程医疗的相对使用率较高有关。研究结果表明,远程医疗是为有社会需求的儿童提供医疗服务的重要方式,但并不能克服社区层面的障碍。
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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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