Abstracts

Rationale: The COVID-19 pandemic prompted a shift from in-person to virtual care, and as a new platform for healthcare delivery, there was limited knowledge about equitable access to it. Initial data at the Children’s Hospital of Philadelphia (CHOP) at the onset of the pandemic suggested that patients of a higher social vulnerability index (SVI) were less likely to complete a neurology telemedicine visit than patients with a lower SVI; however, drivers for this were unknown. Thus, as a first step to prevent disparities, we wanted to determine if access or use of telemedicine technology were contributing factors in lower telemedicine utilization. _x000D_
Methods: We identified 24 high SVI epilepsy patients of two neurologists and divided them into two cohorts: those who had participated in a telemedicine visit at the onset of the COVID-19 pandemic with those in the same timeframe who did not. Each cohort was administered the same survey which assessed their ability to access and activate the patient portal, MyCHOP (which is the telemedicine platform), any perceived barriers, and overall telemedicine utilization. Survey responses were coded and then analyzed in Atlas ti v7 for emerging themes using grounded theory and the constant comparative method.

Results: We reached thematic saturation after enrollment of 24 patients and analysis of 10 surveys. Please reference Figure 1 for demographic information broken down by Group 1 (non-telemedicine cohort) and Group 2 (telemedicine cohort). We found that responses regarding activation experience were similar between cohorts: both groups had the required technology (a smart device and WiFi), were easily able to follow activation instructions, and verified that they were able to view lab results and make appointments though the portal. The non-telemedicine cohort, however, generally reported being less familiar with the patient portal after activation (Figure 2). Both groups identified similar barriers to utilization of the patient portal, such as remembering passwords, site navigation, and limited awareness of all the capabilities of the portal, including its use for telemedicine. Please reference Figure 2 for additional survey responses from each cohort.

Conclusions: After comparing survey responses, we found that patient portal activation was not a major limiting factor for telemedicine participation. We identified that patients with high SVI generally reported multiple barriers with the patient portal, regardless of whether they had participated in a telemedicine visit. Thus, the portal itself may be a contributing factor in the overall decreased use of telemedicine. To ensure equitable care access for patients with high SVI, we continue to investigate the barriers preventing higher engagement with the patient portal but are also ensuring ongoing access to in-person visits.

Funding: Grant funding was provided by the United States Health Resources and Services Administration.