Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA.
Section of Dermatology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA.
Pediatr Dermatol. 2022 Jul;39(4):520-527. doi: 10.1111/pde.14982. Epub 2022 Mar 18.
BACKGROUND/OBJECTIVES: The COVID-19 pandemic necessitated rapid implementation of telemedicine at medical centers across the United States. As telemedicine is expected to persist beyond the pandemic in subspecialties like pediatric dermatology, there is growing concern that socioeconomic factors may contribute to inequitable telemedicine access. This study aims to identify factors associated with disparities in telemedicine use among pediatric dermatology patients during the pandemic.
In this single-center cross-sectional study, patients less than 18 years old who completed a visit with a pediatric dermatologist via a video telemedicine call or in-person office visit during the specified time periods were included. Univariate and multivariable analyses were performed to compare demographic factors for (1) patients who had a telemedicine visit versus office visit during June 1, 2020, to January 22, 2021, and (2) patients who had either visit type during June 1, 2020, to January 22, 2021, versus June 1, 2019, to January 2020.
The independent factors associated with lower odds of telemedicine include identifying as Black/African American, having a non-English preferred language, and having public insurance, whereas the independent factors reducing overall access to pediatric dermatology care during the pandemic include identifying as Hispanic/Latino and having public insurance.
Differential telemedicine use in vulnerable communities may be attributed to disparities in technology access and digital literacy and should be addressed at a structural level. If such disparities are identified and adequately remedied, telemedicine can serve as an important tool for expanding access in the field of pediatric dermatology.
背景/目的：COVID-19 大流行促使美国各地的医疗中心迅速实施远程医疗。由于预计远程医疗在儿科皮肤病学等亚专业领域将持续存在，人们越来越担心社会经济因素可能导致远程医疗机会不平等。本研究旨在确定与大流行期间儿科皮肤病学患者远程医疗使用差异相关的因素。
在这项单中心横断面研究中，纳入了在指定时间段内通过视频远程医疗电话或亲自在办公室就诊完成儿科皮肤科医生就诊的 18 岁以下患者。进行了单变量和多变量分析，以比较（1）2020 年 6 月 1 日至 2021 年 1 月 22 日期间进行远程医疗就诊与办公室就诊的患者的人口统计学因素，以及（2）在 2020 年 6 月 1 日至 2021 年 1 月 22 日期间进行任何一种就诊类型的患者的人口统计学因素，与 2019 年 6 月 1 日至 2020 年 1 月 20 日相比。
与远程医疗就诊可能性降低相关的独立因素包括：黑人/非裔美国人、首选语言不是英语和拥有公共保险，而在大流行期间总体儿科皮肤科就诊机会减少的独立因素包括：西班牙裔/拉丁裔和拥有公共保险。
弱势社区远程医疗使用的差异可能归因于技术获取和数字素养方面的差异，应在结构层面上加以解决。如果发现这些差异并进行适当补救，远程医疗可以作为扩大儿科皮肤科领域就诊机会的重要工具。
