Disparities in Telehealth Utilization in a Population of Publicly Insured Children During the COVID-19 Pandemic

Sen, Bisakha; Sharma, Pradeep; Brisendine, Anne E.; Blackburn, Justin; Morrisey, Michael A.; Menachemi, Nir; Liu, Ye; McDougal, Julie; Sanders, Teela; Becker, David J.

doi:10.1089/pop.2021.0343

Cited by 12 publications

(8 citation statements)

References 30 publications

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“…Third, we used income and marital status as a proxy for socioeconomic status, but could not include race-ethnicity information, thus our ability to fully investigate disparities in telehealth utilization is limited. Finally, this study excluded non-English speakers, who may have lower rates of telehealth utilization compared to the overall population and may face barriers that are unique to them [ 5 ]. Hence, future studies on barriers to telehealth utilization in this Deep South region should include a more diverse population and include analysis on racial disparities.…”

Section: Discussionmentioning

confidence: 99%

“…Results from surveys on telehealth use among adult patients indicate that approximately 23% of patients used telehealth, with higher utilization among publicly insured patients, low-income patients, and patients of color [ 3 , 4 ]. At the same time, at least one study on publicly insured children's telehealth use indicates that lower-income pediatric patients and patients of color are less likely to use telehealth [ 5 ]. Thus, findings about telehealth use and barriers to telehealth utilization among adult patients may not be generalizable to pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

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Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak

Rahim

Ghosh

Brisendine

et al. 2023

BMC Health Serv Res

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Background Telehealth can improve access to evidence-based care at a lower cost for patients, especially those living in underserved and remote areas. The barriers to the widespread adoption of telehealth have been well documented in the literature. However, the barriers may not be the same for pediatric patients, who must rely on their parents or guardians to make healthcare decisions. This paper presents some of the leading barriers parents or guardians of pediatric patients report in using telehealth to meet their children’s healthcare needs. Methods This cross-sectional survey was conducted in a tertiary care pediatric Emergency Department (ED) at a children’s hospital in Alabama between September 2020 to December 2020. The parents or guardians of pediatric patients were asked about their reasons for not using telehealth despite having healthcare needs for their children, whether they canceled or rescheduled healthcare provider visits and facility visits, and whether the child’s health conditions changed over the past three months. Descriptive analyses were conducted that explored the distribution of telehealth use across the variables listed above. Results Five hundred ninety-seven parents or guardians of pediatric patients participated in the survey, and 578 answered the question of whether they used telehealth or not over the past three months. Of them, 33.1% used telehealth, 54.3% did not, and 12.6% did not have healthcare needs for their child. The leading reason for not using telehealth was that the doctor or health provider did not give them a telehealth option, the second main reason was that they did not know what telehealth is, and the third leading reason was that the parents did not think telehealth would help meet healthcare needs for their child. Conclusions This study highlights the telehealth utilization barriers among underserved pediatric populations, including the need for physicians to proactively offer telehealth options to parents or guardians of pediatric patients. Improving health literacy is of paramount importance, given that a substantial proportion of parents were not familiar with telehealth. Policymakers and healthcare organizations should raise awareness about the benefits of telehealth which can improve healthcare access for underserved pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak

Rahim

Ghosh

Brisendine

et al. 2023

BMC Health Serv Res

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“…A study of psychiatric intensive outpatient services that transitioned to telehealth at the start of the COVID-19 pandemic found that adolescents' attendance was higher only for privately insured youths but not for publicly insured youths [9]. Another investigation of claim data among publicly insured children similarly found that those with the lowest income had overall lower rates of telehealth use [34]. It is notable that research on adults shows no difference in attendance and retention for telehealth between publicly and privately insured individuals, although publicly insured adults had lower attendance for in-person services [10].…”

Section: Telehealth Iops Engagement and Insurance Typementioning

confidence: 99%

Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

Gliske¹,

Berry²,

Ballard

et al. 2022

JMIR Form Res

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Background COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes.

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“…The first is the risk of technologically driven care creating new health care disparities. While it has the potential improve access and reach of care, to achieve this requires that devices such as smartphones and infrastructure such as internet access and adequate data plans are equitably distributed, yet it is well established that this is not the case 39–41 . This must be considered and mitigated while digitally augmented care is in relative infancy.…”

Section: Commentarymentioning

confidence: 99%

Unremitting Suicidality in Borderline Personality Disorder: A Single Case Study and Discussion of Technology in Clinical Care

Choi-Kain

Murray²,

Goldblatt³

et al. 2022

Harv Rev Psychiatry

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Disparities in Telehealth Utilization in a Population of Publicly Insured Children During the COVID-19 Pandemic

Cited by 12 publications

References 30 publications

Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak

Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak

Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis

Unremitting Suicidality in Borderline Personality Disorder: A Single Case Study and Discussion of Technology in Clinical Care

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