Telemedicine Visits to Children During the Pandemic: Practice-Based Telemedicine Versus Telemedicine-Only Providers

Ray, Kristin N.; Wittman, Samuel R; Yabes, Jonathan G.; Sabik, Lindsay M.; Hoberman, Alejandro; Mehrotra, Ateev

doi:10.1016/j.acap.2022.05.010

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…17 These data include all care paid for by the health plan, including ED, hospital, and outpatient visits, and have been used in many prior analyses to describe care patterns in the US. [18][19][20][21] We included youth aged 5 to 17 years enrolled in both medical and behavioral health coverage in a given month. To maximize representativeness of our sample, we did not require continuous enrollment in the plan for the full study period.…”

Section: Methodsmentioning

confidence: 99%

“…In the US, 62% of youth 18 years and younger have commercial insurance; those who do are more likely to be Asian or White and have higher family income than youth with public insurance . These data include all care paid for by the health plan, including ED, hospital, and outpatient visits, and have been used in many prior analyses to describe care patterns in the US . We included youth aged 5 to 17 years enrolled in both medical and behavioral health coverage in a given month.…”

Section: Methodsmentioning

confidence: 99%

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Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

et al. 2023

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ImportanceUnderstanding how children’s utilization of acute mental health care changed during the COVID-19 pandemic is critical for directing resources.ObjectiveTo examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic.Design, Setting, and ParticipantsThis cross-sectional analysis of national, deidentified commercial health insurance claims of youth mental health ED and hospital care took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17 614 and 16 815 youth had at least 1 mental health ED visit in the baseline year (March 2019-February 2020) and pandemic year 2 (March 2021-February 2022), respectively.ExposureThe COVID-19 pandemic.Main outcomes and measuresThe relative change from baseline to pandemic year 2 was determined in (1) fraction of youth with 1 or more mental health ED visits; (2) percentage of mental health ED visits resulting in inpatient psychiatry admission; (3) mean length of inpatient psychiatric stay following ED visit; and (4) frequency of prolonged boarding (≥2 midnights) in the ED or a medical unit before admission to an inpatient psychiatric unit.ResultsOf 4.1 million enrollees, 51% were males and 41% were aged 13 to 17 years (vs 5-12 years) with 88 665 mental health ED visits. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits (95% CI, 4.7%-8.8%). Among adolescent females, there was a larger increase (22.1%; 95% CI, 19.2%-24.9%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4% (95% CI, 5.5%-11.2%). Mean length of inpatient psychiatric stay increased 3.8% (95% CI, 1.8%-5.7%). The fraction of episodes with prolonged boarding increased 76.4% (95% CI, 71.0%-81.0%).Conclusions and relevanceInto the second year of the pandemic, mental health ED visits increased notably among adolescent females, and there was an increase in prolonged boarding of youth awaiting inpatient psychiatric care. Interventions are needed to increase inpatient child psychiatry capacity and reduce strain on the acute mental health care system.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

et al. 2023

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“…During the first 18 months of the pandemic, the vast majority of pediatric telemedicine visits were provided by PCPs, as opposed to DTC telemedicine. 3 In 1 study 10 during the first year of the COVID-19 pandemic, antibiotic prescribing at PCP telemedicine visits was lower than PCP in-person visits, with high guideline concordance through both modalities. These findings provide support again to the idea that context rather than technology itself may be a key factor in prior findings.…”

Section: Introductionmentioning

confidence: 98%

“…Acute respiratory tract infections include a cluster of viral and bacterial infections, such as acute otitis media, sinusitis, streptococcal pharyngitis, and viral upper respiratory tract infections, which make up 20%-50% of acute pediatric visits across different settings. [2][3][4] Prior research showed substantially higher antibiotic prescribing to children during DTC telemedicine visits compared with in-person visits provided by primary care practitioners (PCPs). 5 Those results left unclear whether this difference was associated with modality of care (telemedicine vs in-person) or context of telemedicine care (eg, primary care vs not primary care).…”

Section: Introductionmentioning

confidence: 99%

“…Direct-to-consumer telemedicine is virtual-only care staffed by clinicians not part of the patient’s primary care practice, offering care on demand to address common acute concerns, such as acute respiratory tract infections (ARTIs). Acute respiratory tract infections include a cluster of viral and bacterial infections, such as acute otitis media, sinusitis, streptococcal pharyngitis, and viral upper respiratory tract infections, which make up 20%-50% of acute pediatric visits across different settings . Prior research showed substantially higher antibiotic prescribing to children during DTC telemedicine visits compared with in-person visits provided by primary care practitioners (PCPs) .…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors

Wittman,

Hoberman,

Mehrotra

et al. 2024

JAMA Netw Open

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ImportancePrior research found that pediatric direct-to-consumer (DTC) telemedicine visits are associated with more antibiotic prescribing than in-person primary care visits. It is unclear whether this difference is associated with modality of care (telemedicine vs in-person) or with the context of telemedicine care (primary care vs not primary care).ObjectiveTo compare antibiotic management during telemedicine visits with primary care practitioners (PCPs) vs commercial direct-to-consumer (DTC) telemedicine companies for pediatric acute respiratory tract infections (ARTIs).Design, Setting, and ParticipantsThis retrospective, cross-sectional study of visits for ARTIs by commercially insured children 17 years of age or younger analyzed deidentified medical and pharmacy claims in OptumLabs Data Warehouse data, a national sample of commercial enrollees, between January 1 and December 31, 2022.ExposureSetting of telemedicine visit as PCP vs DTC.Main Outcomes and MeasuresThe primary outcome was percentage of visits with antibiotic receipt. Secondary outcomes were the percentages of visits with diagnoses for which prescription of an antibiotic was potentially appropriate, guideline-concordant antibiotic management, and follow-up ARTI visits within the ensuing 1 to 2 days and 3 to 14 days. The ARTI telemedicine visits with PCP vs DTC telemedicine companies were matched on child demographic characteristics. Generalized estimated equation log-binomial regression models were used to compute marginal outcomes.ResultsIn total, data from 27 686 children (mean [SD] age, 8.9 [5.0] years; 13 893 [50.2%] male) were included in this study. There were 14 202 PCP telemedicine index visits matched to 14 627 DTC telemedicine index visits. The percentage of visits involving receipt of an antibiotic was lower for PCP (28.9% [95% CI, 28.1%-29.7%]) than for DTC (37.2% [95% CI, 36.0%-38.5%]) telemedicine visits. Additionally, fewer PCP telemedicine visits involved receipt of a diagnosis in which the use of antibiotics may be appropriate (19.0% [95% CI, 18.4%-19.7%] vs 28.4% [95% CI, 27.3%-29.6%]), but no differences were observed in receipt of nonguideline-concordant antibiotic management based on a given diagnosis between PCP (20.2% [95% CI, 19.5%-20.9%]) and DTC (20.1% [95% CI, 19.1%-21.0%]) telemedicine visits. Fewer PCP telemedicine visits involved a follow-up visit within the ensuing 1 to 2 days (5.0% [95% CI, 4.7%-5.4%] vs 8.0% [95% CI, 7.3%-8.7%]) and 3 to 14 days (8.2% [95% CI, 7.8%-8.7%] vs 9.6% [95% CI, 8.8%-10.3%]).Conclusions and RelevanceCompared with virtual-only DTC telemedicine companies, telemedicine integrated within primary care was associated with lower rates of antibiotic receipt and follow-up care. Supporting use of telemedicine integrated within pediatric primary care may be one strategy to reduce antibiotic receipt through telemedicine visits.

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On-time childhood vaccination before and during the COVID-19 pandemic in seven communities: Findings from the New Vaccine Surveillance Network

Hofstetter,

Klein,

Strelitz

et al. 2024

Vaccine

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Telemedicine Visits to Children During the Pandemic: Practice-Based Telemedicine Versus Telemedicine-Only Providers

Cited by 7 publications

References 14 publications

Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

Trends in Acute Care Use for Mental Health Conditions Among Youth During the COVID-19 Pandemic

Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors

On-time childhood vaccination before and during the COVID-19 pandemic in seven communities: Findings from the New Vaccine Surveillance Network

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