Disparities in the expansion of telemedicine in pediatric specialty care through the COVID-19 pandemic and beyond.

Introduction: The COVID-19 pandemic resulted in the rapid expansion of telemedicine, including in specialties traditionally dependent on physical exams, such as pediatric surgery. Trends in its utilization as in-person visits resumed are not well understood, nor is its effect on mitigating disparities related to social determinants of health (SDOH). We hypothesize that telemedicine utilization increased after the pandemic and has remained higher compared to pre-pandemic levels. Additionally, we hypothesize that increased telemedicine use has contributed to lower no-show rates and more equitable access to care. Methods: A retrospective cohort analysis was conducted of all outpatient visits at a single outpatient pediatric surgery clinic at a quaternary academic center from 01/02/2018 to 10/26/2022. Clinical variables extracted included demographic data, no-show rate (patient did not attend scheduled appointment), and visit type (in person vs telemedicine). Geocoded census data was used to determine SDOH variables such as internet and computer access. A mixed effect logistic regression model was performed to identify which variables were associated with differences in telemedicine usage. Results: 6339 encounters for 2735 patients were analyzed. Odds of presenting to a scheduled telemedicine visit compared to an in-person visit was 0.76 (CI 0.63-0.91, p-value < 0.01). The odds of selecting a telemedicine visit decreased by 34 % for Spanish speakers and 63 % for 'other' language speakers compared to English speakers (p-value < 0.01). The odds of choosing a telemedicine visit also decreased by 4 % for every one-unit increase in the probability of having access to the internet (p < 0.01). There was no significant difference in the odds of choosing a telemedicine visit for insurance status, age, distance, or probability of having access to a computer. Discussion: Telemedicine continues to be utilized at higher rates compared to pre-pandemic levels, but does not reduce no-show rates, which may reflect limits in its clinical utility. It is used less frequently by non-English speakers, which may contribute to ongoing disparities in access to specialty pediatric care.