North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Statement for Telehealth

Franciosi, James P.; Berg, Elizabeth; Rosen, John M.; Lee, Jennifer A.; Sandberg, Kelly C.; Srinath, Arvind I.; Setty, Mala; Li, B U K

doi:10.1097/mpg.0000000000003754

Cited by 6 publications

(3 citation statements)

References 78 publications

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“…A recent position paper from the Telehealth Special Interest Group of the North American Society of Gastroenterology, Hepatology, and Nutrition states that individuals and professional organizations should support digital health equity ( 1 ). Rapid expansion of remote health care access using real-time, 2-way voice, and video communication (known as synchronous telehealth), has been essential in maintaining continuity of care for pediatric gastroenterology (GI) during the COVID-19 public health emergency (PHE).…”

mentioning

confidence: 99%

Equity and Inclusion in Pediatric Gastroenterology Telehealth: A Study of Demographic, Socioeconomic, and Digital Disparities

Mougey¹,

Judy

Venkatesh

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: The purpose of our study is to compare in-person and telehealth pediatric care ambulatory visits for gastroenterology (GI) at the Nemours Children’s Health System in the Delaware Valley (NCH-DV) based on geospatial, demographic, socioeconomic, and digital disparities. Methods: Characteristics of 26,565 patient encounters from January 2019 to December 2020 were analyzed. U.S. Census Bureau geographic identifiers were assigned to each participant and aligned with the American Community Survey (2015–2019) socioeconomic and digital outcomes. Reported odds ratios (OR) are telehealth encounter/in-person encounter. Results: GI telehealth usage increased 145-fold in 2020 compared to 2019 for NCH-DV. Comparing telehealth to in-person usage in 2020 revealed that GI patients who required a language translator were 2.2-fold less likely to choose telehealth [individual level adjusted OR (I-ORa) [95% confidence interval, CI], 0.45 [0.30–0.66], P < 0.001]. Individuals of Hispanic ethnicity or non-Hispanic Black or African American race are 1.3–1.4-fold less likely to utilize telehealth than non-Hispanic Whites (I-ORa [95% CI], 0.73 [0.59–0.89], P = 0.002 and 0.76 [0.60–0.95], P = 0.02, respectively). Households in census block groups (BG) that are more likely to utilize telehealth: have broadband access (BG-OR = 2.51 [1.22–5.31], P = 0.014); are above the poverty level (BG-OR = 4.44 [2.00–10.24], P < 0.001); own their own home (BG-OR = 1.79 [1.25–2.60], P = 0.002); and have a bachelor’s degree or higher (BG-OR = 6.55 [3.25–13.80], P < 0.001). Conclusions: Our study is the largest reported pediatric GI telehealth experience in North America that describes racial, ethnic, socioeconomic, and digital inequities. Advocacy and research for pediatric GI focused on telehealth equity and inclusion is urgently needed.

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confidence: 99%

Equity and Inclusion in Pediatric Gastroenterology Telehealth: A Study of Demographic, Socioeconomic, and Digital Disparities

Mougey¹,

Judy

Venkatesh

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Care delivered via telemedicine has inherent limitations including the inability to complete hands-on physical examinations, collect anthropometrics, obtain point-of-care testing, and administer medications and immunizations. Additionally, consultation with ancillary service providers may be affected, though multiple publications have cited successful implementation of multidisciplinary care in pediatric IBD via telemedicine, and a recent publication outlined best practices for the application of telemedicine in pediatric gastroenterology care (49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care

Michel

Gorham

Lee

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OV) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. Methods: We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center April 2019-December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. Results: Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine vs. OV (46 (IQR 35-72) vs. 62 (IQR 51-80) minutes; P<0.001) with no significant difference in time spent with provider (28 (IQR 21-41) vs. OV 30 (IQR 24-39) minutes; P=0.08). Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 (P<0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office (P<0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine (P=0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs. audio-only; P=0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits (P<0.05 for all comparisons). Conclusions: Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.

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“…We have also encountered families who so enjoy the convenience of telehealth that they are reluctant to return to in-person care. The absence of recent physical examination or anthropometric data is limiting, particularly when virtually evaluating children with poor growth or enteral tube dependence (11). Some caregivers have even pursued telehealth visits in the absence of the pediatric patient, creating a billing and risk management conundrum.…”

Section: Current Challenges In Telehealth Utilizationmentioning

confidence: 99%