290 - Trust in Primary Care Provider and Telehealth Use in a Diverse Pediatric Primary Care Population

Poster Number: 290
Publication Number: 290.346

Shani Jones, Vanderbilt University Medical Center, Nashville, TN, United States; Evan C. Sommer, VUMC, Nashville, TN, United States; Laura E. Adams, Vanderbilt University Medical Center, Nashville, TN, United States; Filoteia Popescu, Vanderbilt University Medical Center, Millersville, TN, United States; Ahmad M. Al-Safi, Vanderbilt University Medical Center, Russellville, KY, United States; Shari Barkin, Vanderbilt University Medical Center, Nashville, TN, United States

Background: During the COVID-19 pandemic, direct-to-patient telehealth (TH) emerged as a distinct form of TH where a patient, rather than a traditional clinic, initiates video-based care from any location to a medical provider. Racial/ethnic minorities, those of low socioeconomic status, and patients with limited English proficiency use traditional TH at low rates. Many factors could also affect utilization rates of direct-to-patient TH among these groups, including trust in health care provider. Little is known about impact of trust in provider (TiP) on adoption of direct-to-patient TH in diverse pediatric populations.

Objective: This study assessed the association between TiP and direct-to-patient video TH use in a diverse primary care pediatric population.

Design/Methods: We conducted a cross-sectional study with a diverse, largely Medicaid population who received care between March to September 2020 in a hospital-based pediatric primary care clinic in TN. The primary outcome was participant direct-to-patient TH use. The validated TiP scale (range: 0-100) measured parent/guardian trust in child’s primary health care provider. Other variables assessed included: COVID-19 family impact (range: 1-4 with higher scores denoting worse impact on family life), TH digital literacy (range: 0-12), and demographic variables. Logistic regression assessed the relationship between TH use, TiP score, and other covariates.

Results: Data from 494 participants (55% English, 30% Spanish, and 14% Arabic-speaking, 80% Medicaid-insured) were analyzed. About one third of respondents indicated TH use since March 2020. TiP score (mean 76.6, SD=14.3) was not significantly associated with TH use after adjusting for relevant covariates, including number of years as a patient in the clinic (OR = 0.999; 95% CI = [0.99, 1.01]; p=0.93). English language preference was strongly associated with TH use (OR=1.99; 95% CI=[1.23, 3.21]; p=0.005) compared to those with non-English language preference. COVID-19 family impact was also significantly associated with TH use (OR=1.70; 95% CI=[1.19, 2.43]; p=0.003) with worse impact related to higher TH use.Conclusion(s): In this diverse primary care pediatric population, TH use differed largely by language, with English-preferring speakers having higher usage rates. Patients with higher COVID-19 family impact also had higher TH use. TiP and other co-variates were not significantly associated with patient-initiated TH use. Solutions to increase access to and use of TH should target systemic barriers related to language and family well-being, rather than individual-level trust.