Predictors of telemedicine utilization in a pediatric neurosurgical population during the COVID-19 pandemic.

Lambert, William A; Leclair, Nathan K; Knopf, Joshua; Mosha, Maua H; Bookland, Markus J; Martin, Jonathan E; Hersh, David S

OBJECTIVE In the wake of the COVID-19 pandemic, telemedicine has become rapidly adopted by the neurosurgical community, however, few studies have examined predictors of telemedicine utilization. Here, we analyze patient variables associated with the acceptance of a telemedicine encounter by a pediatric neurosurgical population during the early phases of the COVID-19 pandemic. METHODS All patients seen in a single institution's outpatient pediatric neurosurgery clinic between 4/1/20 and 7/31/20 were retrospectively reviewed. Demographic variables were collected for each patient's first completed encounter. Patients participating in telemedicine were compared to those seen in-person. Univariate analysis was performed using Wilcoxon rank sum test for continuous variables and Fischer's exact test for categorical variables. A logistic regression multivariable analysis was then performed. RESULTS 682 patients were included (374 telemedicine and 308 in-person). Univariate analysis demonstrated telemedicine visits were more likely to occur at earlier study dates (p<0.001), be established rather than new patients (p<0.001), White or Caucasian (p<0.001), not Hispanic or Latino (p<0.001), English-speaking (p<0.001), non-Medicare/Medicaid recipients (p<0.001), have lower no show rates (p=0.006), and live further from the hospital (p=0.005). Multivariable analysis demonstrated older age (p=0.031), earlier appointment date (p<0.01), established patient status (p<0.001), English-speaking (p<0.02) and non-Medicare/Medicaid insurance (p<0.05) were significant predictors of telemedicine utilization. CONCLUSIONS Significant demographic differences exist among pediatric patients who participated in telemedicine vs. those who requested an in-person visit at our institution. Addressing barriers to access will be crucial for promoting health equity in continued utilization of telemedicine.