PDF(Pubmed)
Abstract：
The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement.
Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality).
We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased.
Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.
Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality).
We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased.
Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.
摘要：
■COVID-19大流行破坏了传统的医疗保健，包括儿科保健。我们描述了大流行对儿科医疗保健参与差异的影响。
■使用基于人口的横截面时间序列设计，我们比较了COVID-19大流行第一年(2020年3月至2021年2月)与大流行前同期(2019年3月至2020年2月)美国大西洋中部4个州0-21岁儿科患者的每月门诊就诊量和完成率(完成与未就诊和取消就诊).我们使用了未经调整的赔率比，按就诊类型(远程医疗或当面)和社会人口统计学特征(儿童种族和种族，照顾者的主要语言，地理编码的儿童机会索引，和乡村)。
■我们检查了1556548个针对不同儿科患者人群的定期门诊就诊。访视量和完成率(平均，70.1%）在大流行的头几个月有所下降，但到2020年6月恢复到流行前的水平。非西班牙裔黑人与非西班牙裔白人患者的面对面就诊完成率差异（64.9％vs74.3％），根据儿童机会指数（65.8%vs76.4%），来自社会经济弱势社区与优势社区的患者在大流行的第一年的剩余时间内，农村和城市社区的患者（66.0％和70.8％）与上一年相比相同。同时远程医疗的大幅增加(0.5%，大流行期间的19.0%)，远程医疗完成率提高。
■大流行前儿科就诊完成率的差异在大流行期间持续存在。这些发现强调了文化上定制的做法的必要性，以减少儿科卫生保健参与的差异。
■使用基于人口的横截面时间序列设计，我们比较了COVID-19大流行第一年(2020年3月至2021年2月)与大流行前同期(2019年3月至2020年2月)美国大西洋中部4个州0-21岁儿科患者的每月门诊就诊量和完成率(完成与未就诊和取消就诊).我们使用了未经调整的赔率比，按就诊类型(远程医疗或当面)和社会人口统计学特征(儿童种族和种族，照顾者的主要语言，地理编码的儿童机会索引，和乡村)。
■我们检查了1556548个针对不同儿科患者人群的定期门诊就诊。访视量和完成率(平均，70.1%）在大流行的头几个月有所下降，但到2020年6月恢复到流行前的水平。非西班牙裔黑人与非西班牙裔白人患者的面对面就诊完成率差异（64.9％vs74.3％），根据儿童机会指数（65.8%vs76.4%），来自社会经济弱势社区与优势社区的患者在大流行的第一年的剩余时间内，农村和城市社区的患者（66.0％和70.8％）与上一年相比相同。同时远程医疗的大幅增加(0.5%，大流行期间的19.0%)，远程医疗完成率提高。
■大流行前儿科就诊完成率的差异在大流行期间持续存在。这些发现强调了文化上定制的做法的必要性，以减少儿科卫生保健参与的差异。
