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Chakawa A, Belzer LT, Perez-Crawford T, Yeh HW. COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use. J Pediatr Psychol 2021; 46:1063-1075. [PMID: 34343329 PMCID: PMC8385826 DOI: 10.1093/jpepsy/jsab077] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Objective The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups. Methods A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1–19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables. Results Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children. Conclusion Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.
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Affiliation(s)
- Ayanda Chakawa
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Leslee Throckmorton Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,The Beacon Program, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Trista Perez-Crawford
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Hung-Wen Yeh
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.,Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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Enkhmaa D, Munkhuu B, Baatar T, Purevsuren J, Minjuur E, Luuzanbadam G, MacKenzie R, Warburton D, Enkhtur S. Overview of Telemedicine Services in Mongolia. CURRENT PEDIATRICS REPORTS 2021; 9:77-82. [PMID: 34258106 PMCID: PMC8270234 DOI: 10.1007/s40124-021-00245-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To highlight some achievements made through usage of telecommunication technologies in Mongolia as an example of a developing country with remote areas. Recent Findings Telemedicine can be implemented not only for remote monitoring, diagnosing, and treating purposes but also can be effectively used for delivering knowledge and consultation services via modern technologies. Summary Tele-health services can be successfully added to the traditional approach of physicians, especially in the countries with a vast territory with distant areas.
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Affiliation(s)
- D. Enkhmaa
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - B. Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - T. Baatar
- UNFPA Country Office, Ulaanbaatar, Mongolia
| | - J. Purevsuren
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - E. Minjuur
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - G. Luuzanbadam
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - R. MacKenzie
- Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - D. Warburton
- Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Sh. Enkhtur
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
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Chrisman SPD, Mendoza JA, Zhou C, Palermo TM, Gogue-Garcia T, Janz KF, Rivara FP. Pilot Study of Telehealth Delivered Rehabilitative Exercise for Youth With Concussion: The Mobile Subthreshold Exercise Program (MSTEP). Front Pediatr 2021; 9:645814. [PMID: 34123963 PMCID: PMC8193501 DOI: 10.3389/fped.2021.645814] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Concussion is common, and up to 30% of youth develop persistent symptoms. Preliminary data suggests treatment with rehabilitative exercise is beneficial, but most programs require frequent in-person visits, which is challenging for youth in rural areas, and has been made more difficult for all youth during the COVID-19 pandemic. We have adapted an exercise intervention to be delivered via telehealth using Zoom and personal fitness devices, which could ensure access to this type of treatment. Objective: The goal of this study was to assess feasibility and acceptability of a telehealth delivered exercise intervention for concussion, the Mobile Subthreshold Exercise Program (MSTEP), and collect pilot data regarding efficacy. Materials and Methods: All youth received the 6-week MSTEP intervention which included wearing a Fitbit and setting exercise heartrate and duration goals weekly over Zoom with the research assistant. Youth completed standardized measures of concussive symptoms (Health Behavior Inventory, HBI), fear-avoidance (Fear of Pain Questionnaire, FOPQ) and health-related quality of life (Pediatric Quality of life Assessment, PedsQL), as well as a structured qualitative exit interview. We examined change in measures over time using mixed effects modeling, controlling for age, sex, prior concussion and duration of symptoms. We coded qualitative interviews using Thematic analysis. Results: We recruited 19 subjects, 79% female with average age 14.3 (SD 2.2) and mean duration of symptoms 75.6 days (SD 33.7). Participants wore the Fitbit on 80% of days, and completed 94% of surveys and 96% of Zoom calls. Concussive symptoms (HBI) decreased significantly over the 6 week intervention (-10.6, 95%CI: -16.0 to -5.1) as did fear-avoidance (-21.6, 95%CI: -29.8 to -13.5). PedsQL improved significantly during the same time period (+15.1, 95%CI: 8.6-21.6). Approximately three-quarters (76%) of youth rated their care as "excellent." Participants appreciated the structure of the guided exercise program and the support of the RA. They also enjoyed being able to track their progress with the Fitbit. Conclusion: This study provides evidence for the feasibility and acceptability of a telehealth delivered rehabilitative exercise intervention for youth with concussion. Further research utilizing a randomized controlled trial is needed to assess efficacy. Clinical Trial Registration: https://clinicaltrials.gov, identifier: NCT03691363. https://clinicaltrials.gov/ct2/show/NCT03691363.
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Affiliation(s)
- Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jason A Mendoza
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Tierra Gogue-Garcia
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kathleen F Janz
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Frederick P Rivara
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States.,Harborview Injury Prevention and Research Center, Seattle, WA, United States
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