ABSTRACT
Purpose/Objectives: The COVID-19 pandemic magnified the longstanding health disparities and unique health needs of adolescents from racially and ethnically diverse backgrounds. With the rapid expansion of telehealth nationally, it is essential that health systems consider how telehealth could influence health equity and be leveraged to meet the needs of diverse populations. We launched a quality improvement (QI) initiative at a large safety-net hospital to assess adolescent and parent perspectives on the use of telehealth, specifically exploring barriers and facilitators to implementation, and then develop recommendations for adapting telehealth practices to optimize care and promote equity for diverse populations of adolescents. Design/Methods: From January-May 2021, we conducted surveys with adolescents ages 12-21 who had a telehealth visit at a county safety-net hospital during the COVID-19 pandemic (n=70) and their parents (n=41). We purposively sampled for adolescents from populations known to be underutilizing telehealth within our system;in our final sample, 39% were Latinx and 33% were Black, with 30% of Black adolescents identifying as Somali. The electronic surveys, which were delivered in English, Spanish or Somali, included questions about respondents': experiences and satisfaction with telehealth;barriers and facilitators to telehealth;experiences of racism and discrimination in healthcare;indicators of high-quality adolescent care and demographics. We analyzed data using descriptive statistics for quantitative variables, and content analysis for qualitative (open-ended) responses. We then hosted four listening sessions with adolescents (n=9) and parents (n=4) to collectively review findings and develop recommendations to optimize care for diverse adolescents and their families. Results: Participants were generally satisfied with telehealth and rated visits highly on quality of care (Figure 1). Commonly reported barriers to telehealth included: difficulty connecting to the visit, a lack of private space, feeling the provider may not be able to evaluate them fully during the visit, and not being able to get labs or imaging. Seven percent of adolescents and 15% of parents reported experiencing discrimination in healthcare, with over one-third (36%) of these experiences occurring during telehealth visits. Nearly half of adolescents (44%) expressed concern that something private from the visit might be shared with their parents, and 10% of adolescents did not have a private space to talk to their providers. Drawing on findings from surveys and listening sessions, we developed recommendations for clinicians and health systems (Table 1) and disseminated them across our hospital system. Conclusion/Discussion: Our QI initiative engaged a diverse population of adolescents and parents in developing recommendations for clinician- and systems-level changes for improving equity in the delivery and, ultimately, access to telehealth care. Our findings have implications, not only for our large safety-net county medical center, but also for other clinics serving racially and ethnically diverse young people. (Table Presented).
ABSTRACT
Purpose: During the COVID-19 pandemic, telemedicine emerged as an alternative option for preventive care for adolescents and young adults (AYAs) when in-person care was not safe or feasible. Yet, it is unclear how the quality of virtual services might differ from in-person. In this quality assessment of Between Us Program data, we compared receipt of recommended reproductive health services (RHS) and human papillomavirus (HPV) vaccination during in-person and telemedicine preventive encounters among AYAs in the Hennepin Healthcare System (HHS) throughout the COVID-19 pandemic. Methods: We conducted a retrospective cohort study including adolescents (ages 10-18) and young adults (YAs, ages 19-26) receiving preventive care at HHS, between January 1st and December 31st, 2020. Patients receiving orders for RHS (contraceptive prescriptions, sexually transmitted infection [STI] screenings) and HPV vaccination were followed to determine if they received the recommended procedures. The rate of ordered procedures (patients receiving order/total patients attending a preventive visit) and completed orders (completed order/patients receiving order) were compared between in-person preventive visits and telemedicine visits using χ2 tests. Stratified analyses were conducted comparing adolescents and YAs. P-values < 0.05 were considered statistically significant. Results: A total of 3,677 adolescents and 1,119 YAs received a preventive visit during 2020. Among them, 4,666 (97.8%) were in-person and 106 (2.2%) were virtual. During these visits, 7.7% of AYAs received orders for contraception (n=368);10.9%, STI screening (n=521), and 36.0%, HPV vaccinations (n=1,720). Contraceptive prescriptions and STI screening orders were similar between in-person and telemedicine visits (7.7% vs. 11.3%, p=0.2982 for contraceptive prescriptions;11.2% vs. 11.3%, p=0.9601 for STI screenings), whereas in-person had higher rates of HPV vaccination orders compared to telemedicine (36.6% vs. 10.4%, p<0.0001). The vast majority of STI screening (86.3%) and vaccination orders (95.8%) were completed, though we were unable to assess contraception order completion. There was a similar rate of STI screenings completed and a higher rate of HPV vaccinations completed during in person visits, when compared to telemedicine (86.2% vs. 91.7%, p=0.5847 for STI screenings, and 95.9% vs 81.8%, p=0.0201 for HPV vaccinations). Stratified analyses revealed no differences in rates of orders or orders completed comparing adolescents and YAs. Conclusions: Telemedicine allowed AYAs who were unable to be seen in-person to receive preventive care during the COVID-19 pandemic. During telemedicine visits, there were similar rates of contraceptive prescriptions and STI screening orders, suggesting that telemedicine may be a viable option for AYA preventive care and should be promoted as an alternative for those with barriers to accessing in-person care during and after the pandemic. Notably, HPV vaccination orders were lower when compared to in-person visits, suggesting that virtual care could lead to gaps in vaccination status. Innovative solutions to ensure vaccine access, such as mobile vaccine outreach, could be paired with telemedicine to help navigate these challenges and were implemented at HHS. Future directions include more comprehensive analyses of recommended preventive services during routine adolescent preventive care. Sources of Support: The Between Us program is funded by the Family Planning Special Projects of the Minnesota Department of Health.