Diversity in Pediatric Telehealth Use is Rising, But Needs a Further Boost

Even as telehealth volumes have declined from their 2020 heights, the service continues to be used by an increasingly diverse pediatric patient population, according to a new study from Nemours Children's Health. But white children still dominate the proportion of the population using telehealth, indicating a need for health systems to spread awareness about the benefits of the service and engage communities of color.

Researchers at the health system, which is headquartered in Jacksonville, Florida, studied the patient population that used its on-demand, urgent care telemedicine service from July 2020 to July of this year. The results were shared at the 2021 SEARCH Telehealth Research Symposium, which was held virtually between Nov. 8 and 10.

The researchers' goal was to determine the changes in language and racial diversity among pediatric patients as telehealth usage stabilized following the initial surge in spring 2020, said lead researcher Dr. Cynthia Zettler-Greeley, in a phone interview.

"The reason for looking at this, beyond just simply knowing who our patients are, is to really have an eye toward maintaining health equity to the best of our ability," she said.

Researchers examined 12,335 pediatric patient encounters extracted from the EHR, which included demographic characteristics like age, race and preferred language. They found that during the study period 53 percent of telehealth patients were white, while 19 percent were Black, 3 percent Asian, and 18 percent mixed/other.

Not only that, but there was continued growth in linguistic diversity of the patients opting to use telehealth, which surprised researchers.

"Whereas initially we had patients who primarily spoke English, and to a lesser extent Spanish…that changed pretty significantly with the advent of COVID," Zettler-Greeley said "What we saw was, patients coming in who spoke Arabic, who spoke Mandarin, Nepali, Portuguese, Tamil, Turkish and so forth."

"The fact that we've continued to see growth in [the linguistic diversity] area in particular is fantastic," she added.

Another key study finding was that 46.3 percent of telehealth patients used government-subsidized health insurance, including Medicaid and the Children's Health Insurance Program.

This is partly due to the relaxed restrictions provided for telehealth reimbursement amid the pandemic, Zettler-Greeley said.

"We certainly call for those [flexibilities] to continue because [the services] are being utilized by our patients," she added.

Though the increase in diverse patients utilizing telehealth is an encouraging sign, it is important to note that white children still formed the largest racial group using the service per the study.

This is likely due to the mistrust that communities of color have in the healthcare system overall, according to Zettler-Greeley.

"What we see in the healthcare system in general is something that we are also experiencing in telemedicine in particular with respect to that disparity," she said.

This means health systems need to do more to gain patient trust and encourage telehealth use among diverse populations.

For its part, Nemours began using a remote medical interpreting service for on-demand telehealth operations in August. This enables the health system to accommodate patients who speak a broad range of languages.

But there is a long way to go with regard to advancing health equity, and gathering and examining data is a good place to start.

"Healthcare systems [should] look at their telemedicine data and the demographic characteristics of the patients and how they have changed with the rapid increase of telemedicine utilization to help really ensure that…they [are] providing equitable care across their patient population," Zettler-Greeley said. "That is really the big take-home message from this work that we want to share."