Telemedicine Transition Exacerbated Racial Disparities in Pediatric Mental Health Care

During COVID-19, the telemedicine transition worsened preexisting racial disparities in pediatric mental health services.

At 2 children’s hospitals in the United States, the transition to telehealth in response to COVID-19 was found to exacerbate preexisting racial disparities in mental health services. These findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Patient records collected between March and April at The Children’s Hospital of Philadelphia (CHOP) and March and September at Boston Children’s Hospital (BCH) prior to COVID-19 (2019) and during the COVID-19 pandemic (2020) were evaluated in this study. The primary outcome was the demographics of patients who had a mental health visit.

Between March and April at CHOP, 2580 patients had a mental health visit in 2019 and 1488 in 2020. Between March and September at BCH, 19,071 patients had a mental health visit in 2019 and 18,585 in 2020.

For the CHOP dataset, in 2019 64% of patients were White and 36% were ethnic minorities. In 2020, 67% were White and 33% minorities (b, 0.15; P =.029). When the analysis was restricted to only sites inside Philadelphia, the decline in the proportion of patients who were minorities in 2020 compared with 2019 was larger (b, 0.47; P =.0003). Similar trends were observed when the analysis was restricted to established patients only (b, 0.39947; P =.00297).

Our study demonstrates that telemedicine services do not necessarily guarantee increased access to care for all populations. Instead, telemedicine may exacerbate extant disparities.

No significant change in insurance status of patients was observed from 2019 to 2020 (b, -0.12; P =.119).

For the BCH dataset restricted to the same 1-month period, 68% of patients in 2019 were White and 32% were minorities and in 2020, 66% were White and 34% were minorities (b, -0.06; P =.190). Unlike at CHOP, significantly more noncommercial insurance holders received care in 2020 than in 2019 (b, 0.38; P =1.77×10-15).

In the 6-month BCH analysis (March to September), 69% of patients were White and 31% were minorities in 2019 compared with 70% and 30% in 2020 (b, 0.07; P =.003), respectively. Similar trends were observed when the data were restricted to only sites inside Boston (b, 0.13; P =.006).

This study may have been limited as parents or guardians were only provided with a limited number of options to self-identify their ethnicity.

Study authors concluded, “Our study demonstrates that telemedicine services do not necessarily guarantee increased access to care for all populations. Instead, telemedicine may exacerbate extant disparities. Mental health service providers, at pediatric hospitals and academic centers broadly, must develop systems to track racial and ethnic disparities and to monitor the progress of initiatives aiming to improve equity and access.”

References:

Williams JC, Ball M, Roscoe N, et al. 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;S0890-8567(22)01895-0. doi:10.1016/j.jaac.2022.07.848