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COVID-19 Era Effect on Pandemic and Post-pandemic Pediatric Telemedicine Use: A Survey of the European Academy of Pediatrics Research in Ambulatory Settings Network

ABSTRACT: Background: During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care. Objective: The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends. Material and methods: Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June–July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine. Results: A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters via telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2–9%), text messages (1–6%), social media (3–11%), cell-phone pictures/video (1–9%), and video conferencing (1–7%) (p < 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (p < 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (p < 0.005). Conclusions: This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.

SUBMITTER: Reingold S

PROVIDER: S-EPMC8570300 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundChildren often suffer from congenital or acquired diseases. Ambulatory cases represent the vast majority of pediatric surgical cases. COVID-19 pandemic-associated regulatory precautions had made the process of seeking medical advice at a suitable appointment such a big problem. We utilized telemedicine (online encounter) to deliver the required healthcare service for sorting and guiding pediatric ambulatory surgical patients. In this article, we aimed to: (1) present our experience, (2) evaluate the effectiveness, and (3) document the results of this technology to solve the problem of difficult healthcare accessibility.Materials and methodsIn this study, we compared the utilization of telemedicine (virtual clinic via video consultation) prospectively in the current era of the COVID-19 pandemic in the period from June 2020 to July 2021 to the in-person clinic encounter at the outpatient department (OPD) retrospectively in the previous year (from June 2019 until the end of May 2020) for perioperative management of pediatric ambulatory surgical patients. The study was conducted at 3 tertiary care pediatric surgery centers. The information recorded for analysis included: demographic data, surgical condition distribution, time interval from the appointment request till the actual encounter with the surgeon, conversation duration, distance traveled, and ultimate fate of the consultations. For both groups, service was evaluated after the first follow-up visit by a patient survey questionnaire (Patient Experience Assessment form) including questions relevant to each encounter.ResultsA total of 1124 pediatric patients with various ambulatory surgical conditions had been scheduled for virtual clinic video encounters. Of them, 1056 cases were evaluated by video consultation, supervised by their parents or caregivers, thus, achieving an attendance rate of 94%. Of the remaining cases, 2% (n = 23) were canceled and 4% (n = 45) did not attend the virtual clinic. Two-thirds of the cases live in rural /remote areas. Patients' overall satisfaction was 92%. This was in comparison to 872 pediatric ambulatory surgical patients scheduled for in-person clinic visits before the implementation of the virtual clinic. Of them, only 340 cases had attended the clinic, thus, achieving an attendance rate of 39%. Of the remaining cases, 450 cases (51.6%) were canceled and 82 cases (9.4%) did not attend the clinic (no show). About 48% of the cases live in rural areas. For this group, patients' overall satisfaction was 63%. The mean encounter duration was similar for both groups (∼ 5 min). Surgical condition distribution was also similar (p-value: 0.694). For new cases, the time interval from appointment request till the actual encounter was very short for the virtual clinic group (range: 6-15 days) as compared to the in-person clinic group (range: 30-180 days). Patients were followed up for a median period of 14 ± 3.25 months (range: 6-22 months) with no patient loss to follow-up.ConclusionTelemedicine can effectively bridge the patient-physician communication gap caused by the regulatory precautions mandated by the current COVID-19 pandemic. It achieved an attendance rate of 94% and parents' / patients' overall satisfaction of 92%.

Project description:Supratentorial primitive neuroectodermal tumors while histologically similar to medulloblastoma is less curable. Gross total resection and therefore early recognition is crucial to a favorable outcome. We report our experience with a 4 year old girl whose clinical course and radiology were atypical. The patient was referred to our center for management of a seizure disorder manifesting as episodic choking, spitting, drooling and vomiting. MRI showed cortical thickening (right perisylvian fissure; right frontal operculum; insula) patchy/gyriform enhancement of the right sylvian fissure resembling angiomatous dysplasia and clusters of dysplastic meningeal vessels. There was no mass effect, midline shift, ventriculomegaly and MRV/MRA were normal. The radiological differential diagnoses offered were polymicrogyria, focal cortical dysplasia, neuronal migrational disorders, neurofibromatosis and Sturge-Webber syndrome. She had no neurological deficits and seizures were controlled with Topiramate/Levetiracetam. Brain CT 3 months later showed focal dystrophic calcification in the right perisylvian region superimposed on the cortical dysplasia again suggestive of a phakomatosis. ASA was commenced to reduce risk of stroke. MRI performed two months later showed progression of leptomeningeal enhancement involving the suprasellar cistern/perimesencephalic cistern, left sylvian fissure, ventral brainstem and cerebellar vermis. There was tumefactive material in the right pre-pontine cistern and right ventricular effacement. Spinal cord MRI done at this time showed diffuse subarachnoid spread. Throughout this period apart from episodic facial pain the patient had no neurological, speech, ocular, cerebellar or major cognitive deficits. A biopsy was performed and histopathology was consistent with supratentorial PNET. CSF was negative for malignant cells. Due to the extent /inoperability of the tumor, minimal possibility of cure/high likelihood of severe treatment related side-effects parents opted for supportive care rather than curative treatment. The patient passed away a few months later. A high index of suspicion and low threshold to biopsy is recommended for early diagnosis of these tumors.

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COVID-19 Era Effect on Pandemic and Post-pandemic Pediatric Telemedicine Use: A Survey of the European Academy of Pediatrics Research in Ambulatory Settings Network

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