PGY-3 Pediatrics Resident Hasbro Children's Hospital, Alpert Medical School of Brown University Providence, Rhode Island, United States
Background: The COVID-19 pandemic decreased pediatric patient volumes in pediatric primary care offices due to patient factors such as lockdowns and fear as well as office factors such as lack of personal protective equipment and space limitations, making it difficult to see sick visits safely. Little is known about how the pandemic has impacted pediatric primary care sick visit utilization.
Objective: To characterize the number of sick visits, types of diagnoses, and use of telehealth in an academic pediatric primary care practice in the first five months of the 2020 COVID-19 pandemic, changes over time, and comparison to sick visits in 2019.
Design/Methods: A retrospective chart review of all sick visits within a large urban academic primary care clinic was conducted from March-July in 2019 and 2020. In-person and telehealth visits for patients up to age 18 were included. Well child visits and follow up visits were excluded. Patient demographics, number of in-person and telehealth visits, and visit trends over time including selected diagnoses are reported with counts and percentages. Monthly visits from 2019 are compared to 2020 using Chi-square test.
Results: 1,534 total sick visits and 220 remote visits were conducted during March-July 2020. Median patient age was 5.5 (IQR, 2-11) and 51% were female, 88.9% had Medicaid (Table 1). Demographics did not vary from 2019 encounters, however patient volume by month was significantly lower. Figure 1 shows visits over time in relation to key local pandemic-related milestones. The proportion of acute otitis, skin, and viral illness diagnoses changed significantly over time in 2020 while genitourinary (GU) and psychiatric/behavioral diagnoses were stable (Figure 2). Conclusion(s): Changes in sick visit volume and type related to the COVID-19 pandemic were seen in an academic pediatric practice, with more overall visits in 2019 but an increase in telehealth visits in 2020. Volume of in-person and telehealth visits also changed by month in 2020, likely related to state and local changes that led to implementation of strategies to limit in-person visits when community transmission was high, especially for infectious complaints. Some diagnoses, like GU complaints, are not as easily managed remotely, thus remained stable. Further research is needed to better understand how these changes may have affected patient care as well as help determine best practices in managing patient flow during different phases of a pandemic while still maintaining access to quality care in a medical home.
Table 1
Figure 1
Figure 2
Authors/Institutions: Jessica M. Kelly, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Delma-Jean Watts, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Allison Heinly, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Shuba Kamath, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Tzu-Chun Chu, Brown University, Providence, Rhode Island, United States; Natalia Golova, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States; Alison Riese, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, United States
.jpg "Jessica M. Kelly, MD, MA photo")
