P1015 - Program Evaluation: A Primary Care Clinic’s Transition During COVID-19

Background

The COVID-19 pandemic has shifted the nature of medical care in pediatric primary care. To mitigate transmission SARS-COV-2 and to preserve the supply of personal protective equipment, CDC guidelines advise limiting non-essential medical visits. However, administering vaccinations, facilitating developmental screening, managing acute medical illness, and identifying and treating mental illness remain of paramount importance to the health of children.

Objectives

This program evaluation explores how a single private primary care clinic shifted over the course of a few weeks from standard on-site ambulatory care to a predominantly telemedicine-based format, with specific protocols for in-person sick visits and well child care (WCC) for infants and toddlers.

Methods

A descriptive survey was undertaken of practice changes occurring in a single, private pediatric primary care clinic during the COVID-19 pandemic. Regulatory changes, payment policy updates, and ethical considerations guided decisions about the utilization of telehealth. Infants six months and under continued to undergo routine on-site WCC. Families of children 9-18 months old were offered a choice of either hybrid telemedicine interviews followed by open-air exam and vaccination conducted in the clinic parking lot, versus routine on-site WCC. Families of children 2 years and older were offered telehealth WCC with on-site exam and vaccination scheduled for 3-4 months ahead. All sick visits were initiated via telehealth, with open-air exam and testing performed if deemed indicated by the provider. Weekly visit number, percentage of well child checks, percentage of acute sick visits, and percentage of mental health visits were assessed through the clinic’s electronic medical record.

Results

Advanced Pediatrics (AP) is a private, suburban pediatric primary care clinic. AP serves approximately 8,000 patients from birth through age 22 years and averages 2000 patient visits per month. In the month prior to the COVID-19 pandemic, >99% of visits were on-site; 28% percent of visits were for WCC, 65% percent for acute illness, and 7% percent for mental health. In the month following the implementation of the COVID-19 telemedicine strategy, the total number of visits decreased by 45%. Telemedicine comprised 82% of visits. WCC accounted 37% of visits, acute medical care 55%, and mental health 8% of visits. At the time of submission, the number and proportion of visits that were WCC as compared to acute medical care visits appeared to be increasing each week.

Conclusion

Utilizing existing technologies and adapting to rapid changes in regulatory and billing policies, a single private practice shifted the provision of pediatric care to a predominantly telemedicine based format, with specific protocols for in-person visits for well and sick children. By sharing lessons learned from this experience, pediatricians may craft universal procedures that can be mobilized in case of future interruptions to the standard model of medical care.