Virtual pediatric acute care visits within the medical home are safe and acceptable to parents

1. In a mixed-methods study, pediatric virtual acute care with a provider from the child’s regular medical home was associated with decreased antibiotic prescribing and no changes in unanticipated emergency visits.

2. Parents gave higher experience scores and appreciated the convenience of virtual care, but had concerns with safety, distractibility, and technology-related difficulties.

Evidence Rating Level: 2 (Good)

Study Rundown: The COVID-19 pandemic has led to unprecedented changes in the delivery of medical care, with a rapid shift to telehealth and virtual care. Previous studies have raised concerns with the quality of care provided during virtual visits in the urgent care setting, especially in regards to inappropriate antibiotic prescribing. Using a mixed-methods design, this study evaluated in-person and virtual acute care visits with the child’s medical home before and during COVID-19, in terms of quality and safety, equity of access, and parent and provider experiences. Virtual care was associated with decreased antibiotic use, higher patient experience scores, and higher likelihood of parents recommending the provider. There were no differences in the rates of unanticipated emergency department visits across visit types. Focus groups were conducted with parents and physicians involved with virtual care. Key concerns with virtual care were patient safety, distractibility of the provider and patient, and technology-related challenges, although both parties appreciated the convenience of virtual care. A significant limitation of the study is the quality outcome measures being limited to unanticipated emergency department visits and antibiotic prescribing, which does not account for other possible adverse outcomes related to virtual visits. Overall, this study supports the notion that telemedicine acute care visits within the context of a child’s regular medical home are safe and effective, although there are some parental concerns that need to be addressed as this modality of care becomes more widespread.

Click here to read the article in the Journal of Pediatrics

Relevant Reading: Telehealth: Improving Access to and Quality of Pediatric Health Care

In Depth [retrospective cohort]: This study used a mixed-methods design and evaluated acute care visits in a virtual and in-person format across three cohorts including (1) in person acute care visits 12 months prior to COVID-19 (Massachusetts state of emergency declaration, March 2020 (2) in person acute care visits during first 12 months of pandemic, (3) virtual acute care visits during first 12 months of pandemic. There were 24,120 in person visits 12 months prior to the pandemic, and there were 6,054 in person visits and 8,688 virtual visits in first 12 months of the pandemic. Virtual visits were associated with 9.6% decrease in all antibiotic use (95% CI -11.5% to -7.8%, p<0.001), higher patient experience scores (p<0.01), and higher likelihood of parents recommending the provider (p<0.05). There were no differences in the rates of emergency department visits across visit type, pandemic period, or time after pandemic-related shutdowns. Two focus groups were conducted with 11 parents who had virtual care visits and one focus group was conducted with six physicians providing virtual care to explore themes related to virtual care experience.

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