Telemedicine Use in a National Pediatric Weight Management Sample During the COVID-19 Pandemic

Background: COVID-19 stay-at-home orders required healthcare providers to adopt new strategies to deliver patient care. Pediatric weight management programs (PWMP) shifted to telemedicine. The objectives of this study were to assess the implementation of telemedicine during the initial COVID-19 period and compare patients during COVID-19 to those pre-COVID in order to investigate potential disparities in accessing care. Methods: This retrospective chart review of 6 US PWMP compared program and patient-level variables during the initial COVID-19 period (spring 2020) and an equivalent pre-COVID period (spring 2019). The COVID-19 period was specific to each PWMP starting when all in-person clinics were closed and ending when any aspect of in-person care resumed. Patients were stratified by visit completion status. Comparisons were made between pre-COVID vs. COVID-19 periods using Fisher's exact tests for proportions and Wilcoxon rank sums tests for continuous variables. Results: Data were analyzed from 3,297 unique patients. Mean duration for the COVID-19 time-period was 9 weeks (range 5-13 weeks). The volume and show rates were lower during COVID-19 (596 completed, show rate 35%) vs. pre-COVID (1,004 completed, show rate 60%). Reimbursement was higher pre-COVID (16.7% vs. 33.3% not reimbursed). During COVID-19, a smaller proportion of patients who completed visits were male, Hispanic, or non-English speaking, and a higher proportion were Black or lived > 20 miles from the program (all values <0.05). For completed visits during COVID-19 vs. pre-COVID periods, insurance status, age and BMI percentile were not significant. Conclusions: Telemedicine was essential during COVID-19 closures. Although reimbursement and patient volumes were lower, telemedicine improved access to those living farther away from a PWMP and those who were Black. Additional strategies are needed to identify and address barriers to telemedicine for those who are Hispanic and non-English speaking.

Families Chose In-Person Visits over Telehealth for Pediatric Weight Management during the COVID-19 Pandemic.

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, telehealth was implemented as a method of care delivery in many pediatric weight management programs (PWMPs). To compare patient/family preference of telehealth vs. in-person visits, we analyzed patient visits during a period when families were given the option of scheduling in-person or telehealth visits for both new and follow-up visits during the pandemic. Methods: A retrospective review was done of our center's electronic medical record of patient visits from July 1, 2020 to December 31, 2020. Results: There were 1356 completed PWMP visits, with 977 (72.1%) done in-person and 379 (27.9%) done by telehealth. Telehealth was selected more often for follow-up visits (31.4%) compared with new visits (18.8%) [odds ratio (OR) = 2.052, p = 0.008]. Black patients (30.5%) selected telehealth more often than White patients (26.1%, OR = 1.371; p = 0.03). Conclusions: Although telehealth increases flexibility and increases options to families, in-person clinic visits seem to be preferred especially for an initial visit.

Body Mass Index Increased at a Large Midwestern Children's Hospital during the COVID-19 Pandemic.

Background: The COVID-19 pandemic has presented a great challenge to children and their families with stay-at-home orders, school closures, decreased exercise opportunities, stress, and potential overeating with home confinement. Our study describes the body mass index (BMI) changes over an entire decade, including a year of the COVID-19 pandemic at a large children's hospital. Methods: With our retrospective observational study, data were extracted from Cincinnati Children's Hospital's Epic electronic medical record, a free-standing children's hospital with 670 inpatient beds and >1.2 million patient encounters per year. Children aged 19 years and under with at least one height and weight were included in the analysis. Results: In all, 2,344,391 encounters were analyzed with 712,945 visits in years 2018-2021. The prevalence of overweight/obesity was relatively stable with a gradual rise from 35% to 36.4% from 2011 to 2020. However, the year of the COVID-19 stay at home and restrictions (2020-2021) showed an increase in overweight/obesity to 39.7% (8.3% increase), with the greatest increase in those with Class 3 obesity from 3.0% to 3.8%. When viewing the change in BMI percentile during the pandemic year compared with the 2 years prior, there was a significantly increasing trend (p < 0.0001). Conclusions: Children attending a large children's hospital showed an increase in overweight/obesity during the COVID-19 pandemic. These data suggest greater efforts are needed to reverse the increase in weight status from the COVID-19 pandemic as obesity is a risk factor for poor outcomes with COVID-19.