Telehealth use for patient care surged early in the coronavirus disease 2019 pandemic.13  Before the pandemic, telehealth was not widely used in pediatrics.46  In a previous survey of 207 early and midcareer primary care pediatricians, conducted early in the pandemic (April 2020), 77% reported using telehealth often at that time, despite 85% reporting never using telehealth before the pandemic.6  We aimed to better understand United States pediatricians’ use of telehealth and perceived effectiveness of different visit types in 2021 by practice specialty.

We used national weighted survey data collected from 3 cohorts of pediatricians participating in the American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES).7,8  Cohorts graduated from residency in 2016 to 2018, 2009 to 2011, or 2002 to 2004; mean age was 43 years in 2021. Initial study sign-up rates for the cohorts ranged from 31% to 41%. PLACES participants are sent 2 surveys each year. During June to August 2021, 2 PLACES researchers (authors M.F. and L.G.) sent a survey, including questions on telehealth (Supplemental Table 2) to half of the PLACES participants (randomly selected n = 1355); 937 (69%) completed the survey. The analytic sample included primary care pediatricians and subspecialists (n = 635); pediatricians in fellowship training, hospitalists, and those in other positions were excluded. The AAP institutional review board approved the study.

We used logistic regression to estimate the independent effect of pediatric practice specialty (primary care versus subspecialist) for telehealth: (1) use in past month, (2) use for 4 patient visit types, (3) overall effectiveness, (4) effectiveness for 4 visit types, and (5) likelihood of pursuing additional telehealth training in the next year. We also included pediatrician characteristics (Supplemental Table 3) in each model. In the results and Table 1, we first present overall unadjusted percentages, followed by predicted values (PVs) for primary care pediatricians and subspecialists for each outcome (1–5 above).9 

Overall, 63.4% of survey respondents reported using telehealth for patient care in the past month; median number of visits was 10. Comparing primary care pediatricians and subspecialists and adjusting for pediatrician characteristics, primary care pediatricians were more likely than subspecialists to report telehealth use in the past month (PV = 77.5, 95% confidence interval [CI] 72.0–83.0 vs 47.9, 39.9–55.8, P < .001; Table 1).

Among pediatricians who reported using telehealth in the past month, overall use for chronic disease management (71.6%), sick visits (68.7%), and mental health visits (57.8%) was more common than for new patient visits (39.1%). Primary care pediatricians were more likely than subspecialists to report using telehealth for sick (PV = 91.3, 95% CI 87.1–95.5 vs 31.9, 20.6–43.2, P < .001) and mental health (PV = 85.0, 95% CI 79.6–90.4 vs 10.3, 4.4–16.2, P < .001) visits and less likely for new patient visits.

Sixty percent reported that overall, telehealth was working very (16.0%) or moderately (44.0%) well at their main work setting. Subspecialists were more likely than primary care pediatricians to report telehealth working well (PV = 68.4, 95% CI 58.6–78.1 vs 55.3, 48.1–62.6, P = .05).

Overall, among pediatricians reporting telehealth use in the past month, 84.9% and 83.9% rated telehealth as very or moderately effective for chronic disease management and mental health visits, respectively. Half rated telehealth as very or moderately effective for sick (49.7%) and new patient visits (48.3%). Subspecialists were more likely than primary care pediatricians to rate telehealth as very or moderately effective for new patient visits (PV= 60.5, 95% CI 46.5–74.6 vs 29.5, 13.1–45.9, P < .05). Few pediatricians reported being likely to pursue additional telehealth training in the next year.

We found that, in the summer of 2021, telehealth use remained common among a national sample of early and midcareer pediatricians. Three-fourths of primary care pediatricians used telehealth for patient care, largely for sick, chronic disease, and mental health visits. In contrast, about half of subspecialists used telehealth for patient care, most commonly for new patient and chronic disease visits.

Study limitations include that data are self-reported and limited to early and midcareer pediatricians. Response to our survey was high, but the initial project signup rate was lower. We made efforts to account for nonresponse bias by weighting the data.7  Our subspecialist group included many different subspecialties. Previous research reported high variability of telehealth experiences across subspecialties.10 

Our study suggests that primary care pediatricians and subspecialists have different experiences overall and by visit type, which is potentially important for future telehealth policy considerations. Strategies to support and sustain telehealth for established patient visits, particularly chronic disease management and mental health care, would align well with perceived effectiveness among clinicians in our study.

Dr Fiks conceptualized the study, participated in the drafting of the manuscript, and reviewed and revised the manuscript; Ms Frintner conceptualized the study, designed the data collection instruments, conducted analyses, participated in the drafting of the manuscript, and reviewed and revised the manuscript; Ms Gottschlich coordinated the collection of data, participated in the drafting of the manuscript, reviewed the analyses, and reviewed the manuscript; Dr Ray conceptualized the study, participated in the drafting of the manuscript, and critically reviewed the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The research presented in this article is that of the authors and does not reflect the official policy of the American Academy of Pediatrics.

FUNDING: Supported by the American Academy of Pediatrics.

CONFLICT OF INTEREST DISCLAIMER: The authors have indicated they have no conflicts of interest relevant to this article to disclose.

AAP

American Academy of Pediatrics

CI

confidence interval

PLACES

Pediatrician Life and Career Experience Study

PV

predicted value

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Supplementary data