O2076: Clinical Use of Telemedicine Visits in Primary Care for Children, 2019-2023

Background: Use of telemedicine within primary care for children has the potential to improve access to clinical care, but data are limited on the evolving use of telemedicine in primary care. We aimed to describe telemedicine use for problem-based visits in primary care for children across a range of clinical domains.

Methods: Our retrospective repeat cross-sectional study examined electronic health record visits from 2019-2023 for children aged < 19 years, from 822 community-based health centers, 76 practices from 2 regional health systems, and 38 independent practices from the AAP Pediatric Research in Office Settings network. Problem-based primary care visits were categorized into clinical domains using the International Classification of Diseases – 10th revision (ICD-10) codes with analysis focused on the 6 clinical domains with greatest telemedicine use: behavioral health (F01-F99), respiratory (J00-J99), endocrine (E00-E90), infectious disease (A00-B99), dermatology (L00-L99), and digestive health (K00-K95). We compared monthly telemedicine vs. in-person visit volume overall and for each clinical domain. We assessed the effect of increased telemedicine visits on in-person visit volume using regression analysis with two-way fixed effects for practice and study months. In this model, a coefficient of -1 would indicate that telemedicine visit volume was offset by an equal decrease in in-person visit volume, with no change in total visit volume (telemedicine + in-person).

Results: The study sample included 13,903,723 problem-based visits (7.0% telehealth, 55.0% Medicaid insured, 13.5% Spanish household language) over the five-year study period. Telemedicine represented less than 1% of all problem-based visits in 2019, peaked at 56.3% of problem-based visits in April 2020, and declined to 7.3% in 2023 (Fig 1). Across clinical domains, telemedicine visits peaked and plateaued at the same times, but at different levels of use (Fig 2). For example, highest telemedicine use in April 2020 occurred for behavioral health (81.8%) and dermatology (67.4%) concerns. In 2023, highest telemedicine use occurred for endocrinology (19.7%) and behavioral health (14.5%) concerns.
Among all problem-based visits, increased telemedicine visit volume was associated with an equivalent decrease in in-person visit volume (coefficient -1.1, 95% confidence interval (CI): -1.3 to -0.9) yielding no change in total visit volume. Exceptions to this pattern were behavioral health (coefficient -0.41, 95% CI -0.6 to -0.3) and endocrinology (coefficient 0.1, 95% CI -0.1 to 0.18), each experiencing a net gain of +0.6 and +1.1 in total visit volume, respectively, for every additional telemedicine visit in these domains.

Conclusion: In 2023, 1 out of every 14 problem-based visits in our sample of primary care sites was conducted through telemedicine, with telemedicine most commonly used for visits for endocrinology and behavioral health concerns. Increased telemedicine visit volume was associated with increased total visit volume for behavioral health and endocrinology concerns, but otherwise did not increase total visit volume.