COVID-19 Sparks Drop in In-Person Visits, Spike in Telehealth Among Children With Asthma

The coronavirus disease 2019 (COVID-19) pandemic led to major shifts in health care utilization among children and teenagers with asthma, according to a new analysis.

The report showed patients were less likely to go to the doctor or hospital, but much more likely to utilize telehealth services. The study was published in the journal Pediatric Pulmonology.

Corresponding author Jillian H. Hurst, PhD, of Duke University, and colleagues, explained that childhood asthma is primarily managed through regular assessment, control of aggravating factors, patient education, and pharmaceutical therapy, all of which require interaction with medical professionals. Yet, as the COVID-19 pandemic took hold, many health care organizations discouraged in-person visits, and many patients and families chose to avoid clinics out of concern about contracting the virus.

Hurst and colleagues wanted to see how those factors translated in terms of patient interactions with the health care system. To find out, they used a cohort of children and teenagers who received care through the Duke University Health System, a network of hospitals, primary care centers, and urgent care clinics in North Carolina.

Hurst and colleagues identified 3,959 children between the ages of 5 and 17 who had previously been diagnosed with asthma, and compared the health care interactions of those patients in the year before the pandemic (March 1, 2019-February 29, 2020) to the healthcare interactions of those same patients in the first year of the pandemic (March 1, 2020-February 28, 2021).

The number of in-person visits, whether for regular check-ups or emergency department visits, shifted significantly. In the first year of the analysis, 66.6% of patients had a well-child check-up. In the second year, when COVID-19 had made it to the United States, the rate dropped to 48.1%. Before the pandemic, 21.0% of the cohort visited the emergency room, but in the pandemic year the number fell to 9.7%. Similarly, 2.5% of the cohort were admitted to the hospital in the year before COVID-19, but the inpatient admission rate fell to 1.6% the following year. Meanwhile, telehealth encounters jumped by more than 100-fold, Hurst and colleagues said.

Though the health record data did not allow investigators to understand the reasons visit rates dropped, Hurst and colleagues wrote that one likely reason is that patients were less likely to encounter triggers for asthma exacerbations. For instance, evidence suggests transmission of human rhinoviruses was significantly reduced as people took precautions like masking and staying at home. Prescription data from the cohort suggests the use of drugs commonly prescribed to treat such viruses was down during the pandemic year.

The authors said the data show use of telehealth was closely related to local COVID-19 conditions and precautions.

“An analysis of EHR data from 45 pediatric primary care practices showed rapid uptake of telehealth within the first month of initiation of stay‐at‐home orders, and continued use through May 2020, with the majority of visits pertaining to mental health and dermatological concerns,” Hurst and colleagues wrote.

Practices that utilized telehealth services saw a lower dip in the total number of encounters (in-person plus telehealth), compared to those not using telehealth, they found.

Though the investigators faced a number of limitations, such as a lack of certain asthma control data, they said the evidence suggests the COVID-19 pandemic might provide useful insights into asthma control.

“​​Future work should seek to fully evaluate the specific factors that contributed to improved outcomes in children with asthma, particularly with respect to factors that could be leveraged after the end of the COVID‐19 pandemic, including the use of telehealth for the provision of care,” they said.

Reference

Hurst JH, Zhao C, Fitzpatrick NS, Goldstein BA, Lang JE. Reduced pediatric urgent asthma utilization and exacerbations during the COVID-19 pandemic. Pediatr Pulmonol. Published online July 21, 2021. doi:10.1002/ppul.25578