Access to primary care telemedicine and visit characterization in a pediatric low-income, primarily Latino population: A retrospective study (Preprint)

BACKGROUND Since the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake in a low income, language diverse community over the long term has yet to be described. OBJECTIVE We aimed to assess the relationship between demographics and patient portal activation and telemedicine visits, as well as characterize diagnoses addressed in telemedicine in a low-income, primarily Latino population over time. METHODS Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for four community-based pediatric practices. The outcome measures included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multiple regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Diagnoses from telemedicine visits were categorized and sub-analyses were conducted to explore variations in diagnoses by age and month. RESULTS There were 12,377 visits overall and 7127 telemedicine visits. Nearly all families (87.5%) had activated the portal, and 33.8% had at least one telemedicine visit. Portal activation and telemedicine visits were highest for patients below 2 years and 15-17 year-olds, and lowest for children from 5-11 years (p <0.001). Non-English speaking (p <0.001) and non-Latino patients (p <0.04) had lower proportions of activation, and decreased odds of having a visit. The top 5 diagnostic categories for telemedicine were infectious disease (26.1%), dermatologic (19.5%), gastrointestinal (11.7%), well or follow-up care (7.0%), and other specialty-related care (6.3%). The infectious disease category showed the most variation over time. Age-based trends included a decrease in the proportion of infectious disease diagnoses by increasing age group, and a higher proportion of well and follow-up care in older age groups. Additional telemedicine usage included common infant concerns for patients under two, pulmonary, asthma, and allergy concerns for school-age children, and genitourinary and gynecologic concerns for older adolescents. CONCLUSIONS Overall, the high level of engagement across demographics, including in Latino patients, suggests feasibility and interest in telemedicine in a low-income, ethnically diverse population. However, language-based disparities were still apparent. Telemedicine was used for a wide range of diagnoses including acute, well care and mental health. Telemedicine may be particularly useful modality to address common pediatric complaints in the infectious disease, gastroenterology and dermatology categories. Our findings have potential implications for strengthening telemedicine policies, such as increasing multilingual outreach, increasing accessibility for specific age groups, and improving triage for the common diagnostic categories. As telemedicine remains a vital component of pediatric healthcare, targeted interventions can enhance accessibility, engagement, and services to serve the diverse needs of pediatric patients and families.