Widening Racial Disparities During COVID-19 Telemedicine Transition: A Study of Child Mental Health Services at Two Large Children's Hospitals

J Am Acad Child Adolesc Psychiatry. 2022 Oct 30:S0890-8567(22)01895-0. doi: 10.1016/j.jaac.2022.07.848. Online ahead of print.

ABSTRACT

OBJECTIVE: To examined whether racial disparities in access to pediatric mental health care were impacted during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH).

METHOD: Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses.

RESULTS: At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a one-month period from 62% to 51% while the proportion of white-identifying patients increased from 38% to 49% (b =, 0.47; z-value, 3.60; p =0.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially-minoritized patients significantly declined within a longer six-month period between 2019 and 2020, from 62% to 59%, while the proportion of white-identifying patients increased from 38% to 41% (b=0.13; z-value=2.8; p=0.006), after controlling for insurance status.

CONCLUSION: At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings may suggest that racially minoritized patients receiving services in urban areas may be particularly at risk of losing access when telemedicine is implemented. While there are limitations to this racial dichotomization, examining differences between white and racially-minoritized patients can highlight ways in which white-identifying have disproportionately received enhanced access to healthcare resources.

PMID:36334891 | DOI:10.1016/j.jaac.2022.07.848