P2D120: Parental Perspectives on Telemedicine in Health Care Delivery in Children with and Without Medical Complexity

Background: Telemedicine has become increasingly common in healthcare delivery since the COVID-19 era. Although there are advantages to telehealth, the barriers to care for children with medical complexity (CMC) and marginalized populations have not been well-described. The purpose of this study was to assess parental perception of telemedicine as a helpful tool in providing care to their children after hospital discharge.

Methods: An anonymous survey via REDcap was distributed to parents of hospitalized patients close to discharge from the hospital. The purpose of the survey was to examine the attitudes of parents regarding the follow up care of their child in the outpatient setting using telemedicine. In order to identify CMCs, families were asked questions about assistive device utilization, functional limitations and subspecialty care requirements. These identifiers have been used from the National Survey of Children’s Health by other studies to identify CMCs in the past. A quantitative and qualitative analysis was performed on parental perspectives.

Results: A total of 99 parents responded to our survey. Of respondents, 58% identified themselves as a minority, 17% reported limited comprehension of English language, 55% had less than a college degree and 62% reported family income of <$100K. Fifty five percent of respondents had used telemedicine previously. A majority of respondents (79%) preferred in-person visits after hospital discharge. Seventy-eight of the respondents provided more detailed answers to our questions about telemedicine and their child’s medical complexity. Fifty four percent of these respondents had a CMC as defined by a need for one or more medical assistive devices. There was no statistical difference between preference for in-person visits versus telemedicine in parents with or without a CMC. However, of the respondents who had experience with telemedicine visit, access to telemedicine was reported to be “very easy” for parents who did not have a CMC compared to those who had a CMC (95% vs. 68%, P=0.04). When free text responses were analyzed, common themes about advantages of in-person visits were a) the physician’s physical exam was valued b) in-person visits were more personal and facilitated clearer communication and c) in-person visits provided more “accurate” care compared to telemedicine (See Figure).

Conclusion: Our preliminary study shows that most parents prefer in-person visits after hospital discharge. Families who did not have a CMC reported easier access to telemedicine comparted to those with a CMC. Further studies are need to characterize why such a difference exists. Thematic information collected can be utilized to improve care and potentially innovate existing telemedicine models.