282 - Child and family factors associated with use of telemedicine for acute respiratory tract infections in 2018-2019

Poster Number: 282
Publication Number: 282.346

Samuel R. Wittman, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Jonathan Yabes, UNIVERSITY OF PITTSBURGH, PITTSBURGH, PA, United States; Lindsay M. Sabik, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States; Kristin Ray, University of Pittsburgh, Pittsburgh, PA, United States

Background: While telemedicine use among children surged due to the COVID-19 pandemic, understanding patterns of telemedicine use prior to the pandemic may help to inform future policy and practice. In 2018-2019, most telemedicine visits to children were provided by commercial direct-to-consumer (DTC) telemedicine companies, with most of these visits for acute respiratory tract infections (ARTI).

Objective: To identify child and family factors associated with use of DTC telemedicine for ARTI in 2018-2019.

Design/Methods: We performed a retrospective cohort analysis of the 2018-2019 claims data from Optum’s de-identified Clinformatics® Data Mart Database (CDM). Adjudicated claims were derived from a large commercial claims data warehouse. We identified children who were ≤17 years old, had ≥6 months continuous enrollment, and were covered by a plan product with DTC telemedicine claims during this period. For each child, we identified outpatient ARTI visits across primary care, emergency department, urgent care, and DTC telemedicine. Among those with ≥1 ARTI visit, we employed mixed logit modeling to examine child and household characteristics associated with ≥1 DTC telemedicine ARTI visit. Independent variables included child-level factors (e.g., age group, sex, race/ethnicity, medical complexity), family-level factors (e.g., education level, household income, household composition), and primary care factors (e.g., provider type, preventive visits), with patient health plan product random intercepts.

Results: Of 1,474,469 included children, 663,387 (45%) had ≥1 ARTI visit from 11,165 unique health plan products. Of those with ARTI visits, 12,925 (1.9%) had ≥1 DTC telemedicine ARTI visit. Among those with ARTI visits, estimated odds of DTC telemedicine use was increased for children with age ≥12 years (OR 1.90, 95% CI 1.67-2.15 vs. age < 1 year), lower parent educational attainment (< high school: OR 1.44, 95% CI 1.06-1.95 vs. bachelor’s degree), higher household income ( >$99,000: OR 1.17, 95% CI 1.09-1.25 vs. < $50,000), and white non-Hispanic race/ethnicity (OR 1.19, 95% CI 1.12-1.26 vs. Hispanic ethnicity).Conclusion(s): In 2018-2019, DTC telemedicine use varied with child age, parent educational attainment, household income, and child race/ethnicity. Future work should explore whether these associations continued into 2020 and beyond, and telemedicine policy should aim to reduce socioeconomic disparities in access to quality care for pediatric ARTI.