Alsaeed Habeeb, Bhatt Maala, Sucha Ewa, Mitsakakis Nicholas, Bresee Natalie, Bechard Melanie
Children's Hospital of Eastern Ontario (CHEO), Department of Pediatrics, Division of Emergency Medicine, Ottawa, Ontario.
University of Ottawa, Faculty of Medicine, Ottawa, Ontario.
Paediatr Child Health. 2025 Apr 1;30(4):244-249. doi: 10.1093/pch/pxae075. eCollection 2025 Jul.
Virtual care can facilitate access to pediatric emergency departments (EDs), but it is unclear if virtual care is equitably accessed by patients from marginalized communities. This study compares the use of a virtual pediatric ED between neighbourhoods with different levels of marginalization.
This is a cross-sectional study of virtual ED visits per neighbourhood (defined by census dissemination area) within 100 km of a tertiary-care pediatric hospital in Ottawa, Ontario, from May to December 2020. Our primary outcome was incidence rate ratios (IRRs) of virtual ED visits for each quintile of the Ontario Marginalization Index's four dimensions: material deprivation, ethnic concentration, residential instability, and dependency. We conducted a negative binomial regression and adjusted for distance from the hospital.
There were 2920 virtual ED visits from 1076 dissemination areas. Compared to the first quintile of material deprivation (wealthier neighbourhoods), there were lower adjusted IRRs of virtual pediatric ED visits for the third (0.80, 95% confidence interval [CI] 0.68 to 0.94), fourth (0.79, 95% CI 0.67 to 0.94), and fifth (0.51, 95% CI 0.42 to 0.61) quintiles. The highest quintile of ethnic concentration (more diverse neighbourhoods) had a lower adjusted IRR compared to the lowest quintile (0.79, 95% CI 0.82 to 0.87). The adjusted IRR for the second quintile of residential instability was slightly higher than the first quintile (1.20; 95% CI 1.02 to 1.41). Adjusted IRR of visits did not vary by dependency.
Wealthier and less ethnically diverse neighbourhoods displayed higher rates of virtual pediatric ED visits, after adjusting for distance to the hospital.
虚拟医疗可促进儿科急诊科（ED）的就诊，但尚不清楚边缘化社区的患者是否能公平地获得虚拟医疗服务。本研究比较了不同边缘化程度社区之间虚拟儿科急诊科的使用情况。
这是一项横断面研究，研究对象为2020年5月至12月安大略省渥太华一家三级护理儿科医院100公里范围内每个社区（由人口普查传播区域定义）的虚拟急诊就诊情况。我们的主要结局是安大略省边缘化指数四个维度（物质匮乏、种族集中、居住不稳定和依赖程度）每个五分位数的虚拟急诊就诊发病率比（IRR）。我们进行了负二项回归，并对距医院的距离进行了调整。
来自1076个传播区域的虚拟急诊就诊有2920例。与物质匮乏程度最低的五分位数（较富裕社区）相比，物质匮乏程度第三（0.80，95%置信区间[CI]0.68至0.94）、第四（0.79，95%CI0.67至0.94）和第五（0.51，95%CI0.42至0.61）五分位数的虚拟儿科急诊就诊调整后IRR较低。种族集中程度最高的五分位数（社区多样性更高）与最低五分位数相比，调整后IRR较低（0.79，95%CI0.82至0.87）。居住不稳定程度第二五分位数的调整后IRR略高于第一五分位数（1.20；95%CI1.02至1.41）。就诊的调整后IRR在依赖程度方面没有差异。
在调整距医院的距离后，较富裕和种族多样性较低的社区虚拟儿科急诊就诊率较高。
