Use of telemedicine in a developmental and behavioural paediatric service during the COVID-19 pandemic:initial experiences of caregivers & providers, singapore

ABSTRACT

BackgroundTelemedicine has been used increasingly as an alternative care model in the Coronavirus 2019 pandemic. The practice of Developmental and Behavioural Paediatrics (DBP) relies heavily on direct child observations and building trust and rapport with caregivers over time and telemedicine was not routinely used in the Singapore setting.ObjectivesWe aimed to describe the initial experiences of caregivers and providers with telemedicine in a DBP service in Singapore during this pandemic.MethodsThis cross-sectional survey included caregivers who accessed telemedicine (through telephone or video-based platforms) and healthcare providers at a tertiary DBP clinic between 8 April and 14 May 2020, coinciding with the Circuit Breaker (similar to a lockdown) period in Singapore. Participants completed a questionnaire on experiences, perceived benefits and limitations of teleconsultation. Descriptive statistics and tests of comparison were conducted.ResultsAround half of the patients (N = 216, 47.3%) who were offered a teleconsultation agreed to it, of which 105 caregivers (48.6%) participated. Caregivers had children with diagnosis including autism spectrum disorder (33.3%), language delay (28.6%), and attention deficit hyperactivity disorder (12.4%). Most caregivers felt that their concerns were adequately addressed (98.1%), with good technological connectivity (95.2%). Majority had no difficulty preparing for the teleconsultation (61.0%) and 44.8% reported ease of follow-up with plans after. Perceived benefits included safety (47.6%) and reduced need to take time off work (24.8%). Perceived benefits included safety (47.6%) and reduced time off work (24.8%). Caregivers who had video-based teleconsultation (compared to telephone-based) had more difficulties preparing for the teleconsultation (52.3% vs 27.4, p=0.03). These caregivers were also more likely to have difficulties with remembering and following up with plans discussed during the consultation, compared to those who had a telephone-based consultation (52.3% vs 25.0%, p value = 0.02).Twenty-five providers participated. Providers included paediatricians, allied health therapists e.g. psychologists, speech and occupational therapists and social workers. Fifty-two percent of providers were as satisfied with teleconsultation compared to in person consults. Only 28.0% of providers rated technology infrastructure to be good. Most providers (92.0%) felt safer with teleconsultation. The most common difficulty perceived by providers was incompleteness of consultation without assessing the child physically. The two main perceived benefits of teleconsultation by providers included feeling safer as they were able to minimize physical interaction with patients and being able to provide similarly good care with less inconvenience to patients.Overall 63.8% of caregivers and 56.0% of providers would continue teleconsultation services post-pandemic. Amongst providers, paediatricians were more likely to continue teleconsultation services after current restrictions were lifted, compared to non-physician providers (100% vs 38.9%, p=0.008).ConclusionsTelemedicine was generally well received by caregiver and physician providers. Teleconsultation in a DBP practice setting is a viable option in a pandemic situation and can be considered even beyond this pandemic for continued care.