Acceptability of Telehealth for Gender-Affirming Care in Transgender and Gender Diverse Youth and Their Caregivers.

Gender-affirming care (GAC) is critical to the well-being of transgender and gender diverse youth and was limited by COVID-19 stay-at-home orders. Telehealth created opportunities for youth to continue receiving lifesaving care. We examined the attitudes of patients (n=21) and caregivers (n=38) receiving telehealth-delivered GAC (TGAC) from May to July 2020. Participants completed surveys after telehealth visits. Descriptive statistics compared telehealth with in-person visits across key domains. Overall, 86.5% of patients and 95.4% of caregivers were satisfied with medical TGAC and 94.3% and 93.3% were satisfied with behavioral health TGAC. Future research should determine the effectiveness of TGAC and identify areas for improvement.

Acceptability of Telemedicine Among Parents of Adolescent Patients in an Adolescent Clinic: Cross-sectional Survey Study.

BACKGROUND: Since the beginning of the COVID-19 pandemic, new literature has described the perceptions of adolescent patients on the use of telemedicine for their health care, but less attention has been devoted to parents' and caregivers' perspectives on telemedicine usage for their adolescents. Parents' perspectives are important, as they undoubtedly influence how children learn to make decisions about their health care. OBJECTIVE: This study describes the level of acceptability (measured based on accessibility and satisfaction) expressed by caregivers of adolescent patients with regard to telemedicine visits in an urban adolescent medicine practice. METHODS: A cross-sectional survey was sent electronically to parents and guardians of patients aged <18 years who completed outpatient telemedicine visits to an adolescent medicine practice in Chicago, Illinois, from March 2020 to February 2021. The questions focused on accessibility and satisfaction. The data were analyzed to describe response frequencies. RESULTS: Among a sample of 71 survey respondents, the vast majority reported that telemedicine was very easy to use (58/71, 82%) and was at least as convenient as in-person visits (70/71, 99%). Over 90% of respondents reported that their adolescents' needs were addressed (69/69, 100%) and that they were at least as comfortable with the level of privacy and the confidential conversations between their adolescents and medical providers in telemedicine visits (65/71, 92%) as they were with those in in-person visits. CONCLUSIONS: Our findings suggest that parents and guardians find telemedicine to be an acceptable way for their children and adolescents to receive appropriate health care.

Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences.

BACKGROUND: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. OBJECTIVE: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. METHODS: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. RESULTS: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. CONCLUSIONS: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.

The Impact of the COVID-19 Pandemic on Sexually Transmitted Infection/Human Immunodeficiency Virus Testing Among Adolescents in a Large Pediatric Primary Care Network.

ABSTRACT: Disruptions in sexually transmitted infection (STI) testing infrastructure during the COVID-19 pandemic threaten to impact STI service delivery for adolescents. Within a large pediatric primary care network, we compared STI testing encounters between the pandemic period and an analogous prepandemic period. The STI test counts decreased and test positivity increased during the pandemic period.

Outcomes of a Rapid Adolescent Telehealth Scale-Up During the COVID-19 Pandemic.

PURPOSE: To describe the first 30 days of rapid adolescent telehealth scale-up in response to the coronavirus (COVID-19) pandemic at a single academic medical center and assess for disparities in visit completion rates by patient characteristics. METHODS: Visit outcome and patient demographic data were obtained via electronic health record (EHR) reports. Telehealth visit completion rates were compared by patient characteristics using the chi-square test and t-test. We used zip code data to generate latitude- and longitude-based maps of the range and density of service delivery. Patient cases highlighting challenges and opportunities for adolescent telehealth were summarized. RESULTS: Between March 16 and April 15, 2020, 392 telehealth visits were scheduled in 331 unique patients, with an 82% appointment completion rate. Video visits were conducted for eating disorders (39%), contraception/menstrual disorders (22%), gender-affirming care (17%), general adolescent medicine (15%), HIV treatment (6%), and substance abuse (1%). The majority of telehealth patients were female Caucasian minors with private insurance. There were no significant differences in telehealth visit completion rates by age, sex, gender, or insurance. Patients coded as non-white (African-American, Asian, or other) in the EHR had lower visit completion rates than white patients (p = .003). Telehealth patients were distributed across five states, with the highest concentration in the zip codes nearest to the clinic. CONCLUSIONS: Rapid scale-up of telehealth for Adolescent Medicine was achieved at this large academic medical center. Future implementation research is needed to assure telehealth reaches adolescents without widening health disparities.