COVID-19, Telehealth, and Pediatric Integrated Primary Care: Disparities in Service Use

J Pediatr Psychol. 2021 Sep 27;46(9):1063-1075. doi: 10.1093/jpepsy/jsab077.


Objective: The coronavirus disease 2019 pandemic (COVID-19) may increase pediatric mental health needs due to its social, economic, and public health threats, especially among Black, Indigenous, and People of Color and those served within disadvantaged communities. COVID-19 protocols have resulted in increased provision of telehealth in integrated primary care (IPC) but little is known about pediatric telehealth IPC utilization during the pandemic for diverse and traditionally underserved groups.

Methods: A comparative study was conducted to explore variability between in-person (pre-COVID-19; n = 106) and telehealth (mid-COVID-19; n = 120) IPC consultation utilization among children 1-19 years old served through a large, inner-city primary care clinic. Logistic regression modeling was used to examine the association between service delivery modality (i.e., in-person vs. telehealth) and attendance, referral concerns, and several sociodemographic variables.

Results: Service delivery modality and attendance, referral concerns, and race/ethnicity were significantly associated. The odds of non-attendance were greater for children scheduled for telehealth, the odds of children with internalizing problems being scheduled for telehealth were greater than those with externalizing problems, and the odds of Black children being scheduled for telehealth were less compared to White children.

Conclusion: Though telehealth has helped provide IPC continuity during COVID-19, findings from this study show troubling preliminary data regarding reduced attendance, increased internalizing concerns, and disparities in scheduling for Black patients. Specific actions to monitor and address these early but alarming indications of telehealth and Covid-19 related behavioral health disparities are discussed.

Keywords: COVID-19; adolescents; anxiety; behavior problems; depression; evidence-based practice; health disparities and inequities; healthcare services and utilization; patient/provider communication; preschool children; primary care; public health; race/ethnicity; school-age children; stress.

MeSH terms

  • Adolescent
  • Adult
  • COVID-19*
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Pandemics
  • Primary Health Care
  • SARS-CoV-2
  • Telemedicine*
  • Young Adult