Pediatric Nephrology Fellow Stanford University School of Medicine Stanford University School of Medicine Redwood City, California, United States
Background: Telehealth (TH) emerged as a significant modality to deliver health care in response to the COVID-19 pandemic. Broad adoption of TH might improve access to subspeciality care but could also further exacerbate inequities in health access by widening the digital divide in healthcare.
Objective: To examine the impact of TH on the equity of access to clinic appointments for pediatric nephrology patients before and during COVID-19 pandemic.
Design/Methods: This cross-sectional study used a retrospective chart review to examine nephrology patients ≤ 18 years old seen at Stanford Children’s Hospital between March-June 2019 (pre-pandemic) and March-June 2020 (pandemic). Demographic information included age, gender, race/ethnicity, payer type, primary language, interpreter use, ZIP code-based poverty level, distance from home to clinic, presence of a severe condition, and new vs. established patient. Download/upload speeds >100/10Mbps at the local level were used to determine broadband availability. Chi-square analysis compared patient characteristics of the pre-pandemic and pandemic cohorts. Multivariable logistic regression examined factors associated with completing appointments.
Results: Overall utilization of care declined in 2020: volume of scheduled appointments decreased by 25% and the odds of completing an appointment were lower (OR 0.2 95% CI 0.1-0.3). TH visits increased from 1% to 58% in 2020. Those who were seen in 2020 were more likely to use TH, to be privately insured, and to speak English or Spanish; the groups were otherwise similar. Utilizing a TH appointment (OR 3.6, 95% CI 2-6.2), having a high-severity diagnosis (OR 4.9, 95% CI 2.2-11.2), and being an established patient (OR 30.9, 95% CI 19.3-49.3) were associated with increased odds of completing a visit. Patients aged 15-18 (OR 0.3, 95% CI 0.1-0.7), of either Asian or Other race (OR 0.4 95% CI 0.2-0.9 and OR 0.4 95% CI 0.2-0.8 respectively), and those with reported income below 3 times FPL (OR 0.4 95% CI 0.2-0.8) had decreased odds of completing a scheduled visit. Availability of broadband was not significantly associated with completing a visit. Conclusion(s): Utilization of nephrology appointments declined at our center in 2020 despite a significant increase in TH visits. For established patients and those with high-severity conditions access to care remained intact. Equity concerns include more access for those with private insurance and less for those who live in low-income zip codes.
Table 1: Patient characteristics with scheduled appointments pre-pandemic and during COVID-19 Pandemic
Table 2: Multivariate logistic regression for completing a scheduled visit in pediatric nephrology.
Authors/Institutions: Sara Kibrom, Stanford University School of Medicine, Redwood City, California, United States; Jill Krissberg, Stanford University School of Medicine, Redwood City, California, United States; Eli Cahan, Stanford University School of Medicine, Stanford, California, United States; Jay R. Maturi, Stanford University, Carmel, Indiana, United States; Olga Saynina, Stanford University, Carmel, Indiana, United States; Elizabeth M. Talley, Stanford University School of Medicine, Redwood City, California, United States; Paul Wise, Stanford University School of Medicine, Stanford, California, United States; Cynthia Wong, Stanford University School of Medicine, Redwood City, California, United States; Lisa J. Chamberlain, Stanford University School of Medicine, Redwood City, California, United States
