Telemedicine and Disparities in Visit Attendance at a Rural Pediatric Primary Care Clinic During the COVID-19 Pandemic.

OBJECTIVE: To determine whether the introduction of telemedicine at a rural pediatric clinic was associated with reduced disparities in visit attendance. METHODS: A retrospective cohort study was conducted of all clinic visits from 1 January 2019 to 31 December 2021. Visit types were divided into telemedicine visits, in-person urgent, and in-person non-urgent visits. Visits were stratified into periods based on the statewide pandemic response. RESULTS: A total of 8,412 patients with 54,746 scheduled visits were analyzed. Visits were less likely to be completed for older patients, Black patients, and patients with Medicaid insurance than their counterparts. Despite a pandemic-era increase in telemedicine utilization, disparities in visit completion that were present in the pre-pandemic era persisted after stay-at-home orders were lifted. DISCUSSION: The adoption of telemedicine did not reduce pre-existing disparities in visit attendance. Further work is needed to identify the reasons for the disparities and improve visit attendance of historically disadvantaged patient populations.

In-person follow-up visit attendance after telemedicine visits.

BACKGROUND: Although Coronavirus disease 2019 rapidly increased the use of telemedicine for pediatric primary care, vaccinations, screening tests, lab draws, and other procedures still require follow-up in-person visits. We investigated in-person follow-up rates after telemedicine visits at our primary care clinic, and what patient or visit characteristics were associated with non-completion of in-person follow-up. METHODS: A retrospective cohort study was conducted of telemedicine visits completed between April and May 2020. A manual chart review was performed to determine which encounters required a follow-up in-person visit; and was tracked through August 2020. Bivariate comparisons were performed according to completion of in-person follow-up and multivariable analysis of follow-up visit attendance was performed using Cox proportional hazards regression. RESULTS: Of 500 eligible encounters, 16% did not attend at least one in-person follow-up. The median time for follow-up was 2 days (IQR: 1, 6). Patients older than 1 year of age (32%, p= <0.001) and with Medicaid insurance (83%, p=0.019) were more likely to not complete a follow-up visit. The likelihood of completion was higher for Hispanic as compared to non-Hispanic Black patients (HR: 1.65; 95% CI: 1.28, 2.12; p<0.001) and patients requiring routine screening (HR: 1.40; 95% CI: 1.04, 1.89; p=0.028). CONCLUSIONS: Not all required in-person follow-ups were completed after telemedicine visits, which could have negative impacts on children's health. Improving the transition between telemedicine and inperson follow-up of primary care can help ensure the quality of care provided in a telemedicine-first model.

Waning of SARS-CoV-2 Seropositivity among Healthy Young Adults over Seven Months.

BACKGROUND: We conducted a longitudinal study to estimate immunity produced in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among university students over seven months. METHODS: All participants were attending a public university and resided in Pitt County, North Carolina. University students enrolled weekly for 10 weeks between 26 August 2020 and 28 October 2020, resulting in 136 young adults completing at least one study visit by 17 November 2020. Enrolled students completed an online survey and nasal swab collection at two-week intervals and monthly blood collection between 26 August 2020 and 31 March 2021. RESULTS: Amongst 695 serum samples tested during follow-up, the prevalence of a positive result for anti-nucleocapsid antibodies (N-IgG) was 9.78%. In 22 students with more than one positive N-IgG serum sample, 68.1% of the group lost persistence of N-IgG below the positive threshold over 140 days. Anti-spike IgG antibodies were significantly higher among 11 vaccinated compared to 10 unvaccinated. CONCLUSIONS: In healthy young adults, N-IgG wanes below the detectable threshold within five months. S-IgG titer remained consistently elevated months after infection, and significantly increased after vaccination.

Well-child visit attendance of children who have experienced a parental COVID-19 diagnosis.

BACKGROUND: Due to the COVID-19 pandemic, rates of well-child visit (WCV) attendance have significantly decreased. We wanted to see how a parent's positive diagnosis for COVID-19 affected a child's WCV attendance along with other factors. Therefore, we hypothesized that in families with at least 1 positive COVID-19 diagnosis, the rates of WCV attendance would be lower than in families that have not experienced COVID-19. METHODS: Using National Health Interview Survey (NHIS) data from 2020, we analyzed sample adult responses for the sample child to questions about last WCV attendance. We included children whose parents completed the survey during quarters 3 and 4 of 2020. The outcome of this study was WCV attendance in the past 12 months with the exposure of interest being parental diagnosis of COVID-19. RESULTS: In our sample (N=1,413), 91% of children attended a WCV in the past 12 months, and 5% had a parent with a positive COVID-19 diagnosis. On adjusted analysis, there was a negative but not statistically significant association between a parent with a positive COVID-19 diagnosis and WCV attendance (OR=0.32; 95% CI: 0.09, 1.20; p=0.092). CONCLUSIONS: Nationwide, there has been a significant decrease in children attending recommended WCVs since the start of the pandemic. Having a parent test positive for COVID-19 may contribute to decreases in WCV attendance in traditional medical office settings. Alternative options exist that may improve WCV attendance; these include telemedicine or virtual visits, as well as visits completed in non-traditional settings such as mobile health clinics and school-based clinics. Further expansion of these options for WCVs must still take into account health disparities that exist among marginalized communities.

Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas.

We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0-18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.

Use of Health Care Services by Pediatrics Residents: A CORNET Study.

BACKGROUND: The personal health practices of residents and their access to health care has not been well explored. Suboptimal personal health care habits and practices among many physicians may evolve during residency. OBJECTIVE: To identify the nature and extent of pediatrics resident health care use and the factors that restrict or facilitate use. METHODS: A web-based survey was sent to pediatrics residents from 19 continuity practice sites enrolled in the nationwide Continuity Research Network (CORNET) during April through June 2010. Outcome measures included self-report of health care use, involvement in an established care relationship with a primary care provider, and barriers residents encountered in receiving care. RESULTS: Of 1210 eligible residents, 766 (63%) completed the survey. Respondents were 73% women; each postgraduate training year was equally represented. More than one-half of residents (54%) stated they had an established care relationship (ECR) with a primary care provider. Interns were less likely to have an ECR when compared with upper level residents; female residents were twice as likely to have an ECR compared with male residents. Although 22% (172 of 766) of the respondents reported they had a chronic health condition, only 69% (118 of 172) of those individuals had an established care provider. The most significant barrier to obtaining health care was resident concern for time away from work and the potential increased workload for colleagues. CONCLUSIONS: A slight majority of pediatrics residents stated they had an established relationship with a primary care provider. The most common barriers to seeking routine and acute care were work related.

Prevention and control of influenza: no easy task.

Every influenza season presents different challenges: Novel viruses emerge, new groups of people are identified as being at high risk for complications, vaccine effectiveness varies, and resistance to antiviral agents develops. Health care providers must partner with public health professionals to prevent influenza and to reduce the morbidity and mortality associated with this illness.

Prevention screening and counseling: strategy for integration into medical education and practice.

Providing optimal preventive services across the life span is integral to improving the nation's health. However, teaching future health professionals evidence-based prevention screening and counseling has notable limitations. Applying the U.S. Preventive Services Task Force (Task Force) preventive services recommendations is necessary but not sufficient to teach comprehensive and practical preventive services delivery. Certain important health topics have not yet been investigated by the Task Force; other Task Force health topics have insufficient evidence or nonspecific recommendations. The purpose of the current paper is to provide a strategy and develop a tool to educate future healthcare professionals in recommendations for prevention screening and counseling. Age-specific preventive history charts for children and adults were created using a total of 60 recommendations from the following sources (with number of recommendations shown): the Task Force (n=37); four primary care professional organizations (n=15); and a representative panel of experts (n=8). Using a systematic approach that incorporates other accredited organizations and inclusion criteria (as described) yielded a practical tool that is applicable in both educational and clinical settings.

An academic/government partnership to provide technical assistance with pandemic influenza planning to local health departments in North Carolina.

In 2006, the North Carolina Division of Public Health (NC DPH) required all 85 local health departments (LHDs) in North Carolina to develop a pandemic influenza plan. Because few LHDs had experience in developing such plans, NC DPH engaged in a unique partnership with an academic center, the North Carolina Center for Public Health Preparedness (NCCPHP), to provide technical assistance to local planners. This article describes the technical assistance program implemented by NCCPHP, the use of technical assistance by local planners, subsequent completeness of local pandemic influenza plans, and lessons learned throughout the program. We discuss selected topic areas (surveillance, vaccine/antiviral, and vulnerable populations) observed within local pandemic influenza plans to highlight the variability in planning approaches and identify potential opportunities for state and local standardization.

Influenza vaccination of healthcare workers: institutional strategies for improving rates.

The nosocomial transmission of influenza has been well documented since the 1970s with both direct and indirect effects of outbreaks in healthcare settings. Outbreaks can directly increase morbidity among patients and residents of long-term care facilities. Indirect effects include disruption of normal operations of healthcare institutions, shortages of healthcare workers (HCWs), fewer elective admissions, and income loss due to absenteeism. Influenza vaccination of United States HCWs remains below 40% despite the availability of a safe, effective vaccine and a long-standing recommendation for vaccination of HCWs. New strategies to improve the rate of influenza vaccination among HCWs are needed as the percentage of those receiving yearly vaccination has changed little in the past 20 years. Increasing HCW influenza vaccination coverage calls for a paradigm shift, institutions should view vaccination of HCWs as a crucial part of a comprehensive infection control program designed to protect patients and staff. Administrators of hospitals, long-term care facilities, and other health agencies should respond to this challenge by developing programs to improve yearly influenza vaccination of their staff Such efforts would put these employees into compliance with national recommendations and also benefit the institution by reducing absenteeism, nosocomial influenza transmission, and the associated economic losses and disruption of routine operations.