Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID‐19 pandemic

Abstract

Aim:To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method:We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Results:We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8; R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). Interpretation: Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.

Suggestions for further research on use of telemedicine in child neurology

“…This is certainly the case for child neurology. 1 However, variations across patient diagnoses, ages, and demographic factors have also been observed. The COVID-19 pandemic offered the opportunity to compare the uptake and outcome of telemedicine.…”

“…Many people involved in health care believe that telemedicine will remain as a long‐term utility, even with the reopening of outpatient clinics in a post COVID‐19 era. This is certainly the case for child neurology 1 . However, variations across patient diagnoses, ages, and demographic factors have also been observed.…”