During COVID-19, we have seen a dramatic rise in the use of telehealth. While rushed into use to reduce the spread of the virus, especially to at-risk individuals, it is likely that telehealth will be here to stay, even post-pandemic.
When the Centers for Medicare and Medicaid Services responded to the pandemic with their guidance on telehealth, they specified that services could be delivered via telehealth to all Medicaid populations, including children, and pediatricians quickly moved to adapt. Telehealth provided a way for pediatricians to mitigate risks and meet the immediate needs of their patients, and it will continue to provide a means for them to deliver care.
However, some visits still require in-person visits. One of the impacts of the pandemic has been a significant drop in well-child visits and a corresponding reduction in vaccinations as families stayed home to reduce the spread of COVID-19. According to the American Academy of Pediatrics, pediatricians were only seeing 20 to 30 percent of the number of patients they typically see in the spring of this year.
Well-child visits are important to:
- Track a child’s growth and development
- Allow adults to discuss any concerns about a child’s health
- Get important vaccinations
And the vaccinations are of particular concern. While COVID-19 has thus far been shown to have less of an impact on children, diseases like measles and whooping cough, pose a greater threat.
Now, as communities have opened back up, how should it be determined when to utilize telehealth and when to schedule in-person appointments? The American Academy of Pediatrics suggested the following guidelines for well-child visits:
- Well-child care should occur in person whenever possible and within the child’s medical home where continuity of care may be established and maintained. For practices who have successfully implemented telehealth to provide appropriate elements of the well exam virtually, these telehealth visits should continue to be supported, followed by a timely in-person visit.
- Pediatricians should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in-person appointments inclusive of newborns, infants, children, and adolescents. Pediatricians should work with families to bring children up to date as quickly as possible.
- Pediatricians should inform families about the strategies already implemented in primary care medical home offices to assure safety. These strategies may include these examples:
- Scheduling well visits and sick visits at different times of the day.
- Separating patients spatially, such as by placing patients with sick visits in different areas of the primary care clinic or another location from patients with well visits.
- Collaborating with providers in the community to identify separate locations for providing well visits for children.
Health plans can make an effort to encourage the health of their youngest members through engagement efforts, including communicating the importance of well visits with parents and guardians; sending reminders to families that have missed appointments; sharing information on when and how to get vaccinations during the pandemic.