A new policy statement from the American Academy of Pediatrics addresses how telehealth can be used to increase patient access to high-quality, cost-efficient primary and subspecialty pediatric care, especially for those in under-resourced areas. The policy also pushes for equitable telehealth access for children and adequate payment for telehealth services.
The policy, "Telehealth: Improving Access to and Quality of Pediatric Health Care," (published in the September 2021 issue of
Pediatrics), urges that the digital transformation of health care address barriers such as language, digital literacy, disability, and access to and payment for technology infrastructure to ensure that underlying disparities are not exacerbated.
With telehealth, there is a need to follow the highest quality standards of clinical care, while also ensuring that technology implementation is not worsening health care disparities—the digital divide.
"Telehealth became more widely available during the COVID-19 pandemic, but not everyone has ideal access to it," said Alison Curfman, MD, MBA, FAAP, an author of the policy and a member of the AAP Section on Telehealth Care Executive Committee. "We must address the absence of technology in some homes, digital literacy issues, and unreliable internet coverage to best serve our patients."
When the health care system is disrupted, as it has been during the COVID-19 pandemic, disparities in access to care can become more problematic. Disruptions can result in neglect of serious medical conditions as well as forgoing needed preventive care and immunizations.
Missed opportunities for care can have serious immediate and long-term consequences for children's health, development, and welfare that are more severe for populations of children affected by inequities based on race/ethnicity, disability, geography, socioeconomic status, and payer policies, according to the AAP.
In the policy statement, the AAP calls for:
Health Equity: Telehealth can decrease disparities in access to care by extending pediatric expertise and best practices to children no matter where they are located.
Access to Pediatric Care: Telehealth can expand the footprint and breadth of pediatric medical and surgical specialties by bringing expertise to remote and under-resourced areas and efficiently directing patients to the most appropriate care settings.
Payment Reform: Payment for telehealth services at parity with the equivalent services provided in person by private insurers, Medicare, and Medicaid/CHIP, including managed care arrangements, will allow the use of the most appropriate place of service for each encounter.
Care Within the Medical Home: Support for the use of telehealth within the medical home recognizes that the medical home offers continuity and the prudent use of health care resources, avoiding fragmented and episodic care delivered without such coordination.
Federal Research Funding: Creation of an evidence base to address best practices, workforce needs, patient access to care, quality of care, reduction of health care costs, and patient/family and clinician satisfaction will enable future research to improve the function of and access to pediatric care via telehealth.
"Telehealth is a great option when families can't make it to a medical office because of transportation issues or out of a fear of missing too much work or because of COVID-19 concerns," Dr. Curfman said. "But we must work together to ensure that we reach everyone who needs care. Practices should set up strong telehealth systems, work with families on technological issues, and follow up to make certain patients are getting the care they need."
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