The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. FormatOpportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.
Key points
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Educational resources that incorporate the most recent evidence on pediatric telemedicine care are needed to promote consistency across providers, increase provider confidence, and improve quality of care.
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Patient-generated data, including remote patient monitoring, could improve the quality of virtual visits, but issues with measurement quality and parent self-efficacy must be addressed.
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Rigorous studies examining specific practices within telemedicine delivery and use are needed to develop evidence-based guidelines around virtual care for pediatric conditions.
- •A focus on equity is essential for ensuring that telemedicine interventions do not widen health disparities.
Introduction
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a dramatic and rapid increase in the adoption and implementation of telemedicine services, including in pediatrics [
]. Many pediatric providers that previously had not offered telemedicine services quickly adopted telemedicine and have continued to provide services well after the start of the pandemic. This shift presents opportunities to expand our understanding of the impact of telemedicine on access to care, quality of care, and health care costs on a broader scale.
The pandemic has changed the way that patients and caregivers, providers, and health systems think about telemedicine. A prepandemic review of the pediatric telemedicine landscape identified licensing requirements, provider interest, lack of resources to train providers, and reimbursement issues as the main challenges facing pediatric telemedicine programs [
]. The Public Health Emergency forced the resolution of many of these challenges, making telemedicine a necessary part of patient care as shelter-in-place orders and other infection prevention measures discouraged in-person encounters. Given that telemedicine will remain a mainstay of pediatric care, the field now faces the challenge of improving the delivery of telemedicine for pediatric patients to ensure that all patients have access to high-quality care [
]. Identifying evidence-based practices and understanding how these practices can be implemented and scaled are the next steps toward meeting this challenge.
Since the start of the pandemic in spring 2020, new research has been published, providing insights into promising practices for pediatric telemedicine, adoption by parents and providers, and barriers and facilitators to telemedicine use. These studies bring to the field great diversity in terms of patients, providers, settings, and specialties; they use larger amounts of data than were possible to collect prepandemic and are pragmatic, based in real-world settings. Understanding the lessons learned is important for optimizing telemedicine delivery going forward. With this in mind, the objectives of this review are to (1) summarize recent evidence on the delivery of telemedicine for pediatric patients with an emphasis on lessons learned during the pandemic and (2) highlight opportunities in telemedicine delivery and research.
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