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Santhakumaran S, Baiad A, Ranjbari D, Correa JA, Chaudhry Z, Toffoli D. Impact of 5 waves of COVID-19 on pediatric ophthalmology. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00187-X. [PMID: 39106963 DOI: 10.1016/j.jcjo.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. METHODS Medical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). RESULTS There was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). CONCLUSION The number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.
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Affiliation(s)
| | - Abed Baiad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Dorsai Ranjbari
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Zoya Chaudhry
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
| | - Daniela Toffoli
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
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Hanson HR, Formica M, Laraque-Arena D, Zonfrillo MR, Desai P, O'Neil JO, Unni P, Johnson EL, Cobb P, Agarwal M, Beckworth K, Schroter S, Strotmeyer S, Donnelly KA, Middelberg LK, Morse AM, Dodington J, Latuska RF, Anderson B, Lawson KA, Valente M, Levas MN, Kiragu AW, Monroe K, Ruest SM, Lee LK, Charyk Stewart T, Attridge MM, Haasz M, Jafri M, McIntire A, Rogers SC, Uspal NG, Blanchard A, Hazeltine MD, Riech T, Jennissen C, Model L, Fu Q, Clukies LD, Juang D, Ruda MT, Prince JM, Chao S, Yorkgitis BK, Pomerantz WJ. A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Inj Epidemiol 2023; 10:66. [PMID: 38093383 PMCID: PMC10717699 DOI: 10.1186/s40621-023-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic. METHODS This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020. RESULTS The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31 years vs 7.31 in 2019), more commonly White (54% vs 50%, p < 0.001), non-Hispanic (72% vs 69%, p < 0.001) and had private insurance (35% vs 32%, p < 0.001). Injury hospitalizations increased 2.2% (p < 0.001) and deaths increased 0.03% (p < 0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p < 0.001) between 2019 and 2020. Injuries declined for struck by/against (- 4.9%) and overexertion (- 1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019. CONCLUSIONS The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.
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Affiliation(s)
- Holly R Hanson
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Margaret Formica
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, New York, New York, USA
- Clinical Epidemiology and Pediatrics, Mailman School of Public Health and Vagelos College of Physicians & Surgeons, Columbia University, Syracuse, NY, USA
| | - Mark R Zonfrillo
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Puja Desai
- Department of Pediatrics, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph O O'Neil
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Purnima Unni
- Department of Pediatric Trauma, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Estell Lenita Johnson
- Department of Epidemiology, School of Public Health, Injury Free Coalition for Kids, Columbia University, New York City, NY, USA
| | - Patricia Cobb
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maneesha Agarwal
- Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kristen Beckworth
- Center for Childhood Injury Prevention, Texas Children's Hospital, Houston, TX, USA
| | - Stephanie Schroter
- Department of Pediatric Emergency Medicine, University of California, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Stephen Strotmeyer
- Department of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Katie A Donnelly
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Leah K Middelberg
- Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amber M Morse
- Division of Pediatric Emergency Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Richard F Latuska
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brit Anderson
- Department of Pediatric Emergency Medicine, Norton Children's Hospital, Louisville, KY, USA
| | - Karla A Lawson
- Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Michael Valente
- Department of Pediatric Emergency Medicine, Children's Health Orange County, Orange, CA, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Waititu Kiragu
- Department of Pediatrics, University of Minnesota and Children's Minnesota, Minneapolis, MN, USA
| | - Kathy Monroe
- Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie M Ruest
- Department of Emergency Medicine, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Hasbro Children's Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Tanya Charyk Stewart
- Department of Paediatrics, University of Western Ontario and London Health Sciences Centre, London, ON, Canada
| | - Megan M Attridge
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Maya Haasz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mubeen Jafri
- Department of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia McIntire
- Department of Pediatric Surgery, Randall Children's Hospital at Emanuel Legacy, Portland, OR, USA
| | - Steven C Rogers
- Department of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Hospital, Hartford, CT, USA
| | - Neil G Uspal
- Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Medical Center, New York City, NY, USA
| | - Max D Hazeltine
- Department of Surgery, UMass Chan Medical School, Worcester, MA, USA
| | - Teresa Riech
- Department of Pediatric Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Charles Jennissen
- Department of Pediatrics, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Emergency Medicine, Roy J. and Lucille A. Carter College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Quinney Fu
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Lindsay D Clukies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Michelle T Ruda
- Department of Pediatrics, Children's Memorial Hermann Hospital, UTHealth Houston, Houston, TX, USA
| | - Jose M Prince
- Department of Pediatric Surgery, Northwell Health, New Hyde Park, NY, USA
| | - Stephanie Chao
- Division of Pediatric Surgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of FL College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Wendy J Pomerantz
- Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Müller F, Munagala A, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Racial disparities in emergency department utilization among patients with newly diagnosed depression. Gen Hosp Psychiatry 2023; 85:163-170. [PMID: 37926052 DOI: 10.1016/j.genhosppsych.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. METHODS In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. RESULTS A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. CONCLUSION Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA; Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
| | - Akhilesh Munagala
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA.
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Rahim MJ, Ghosh P, Brisendine AE, Yang N, Roddy R, Broughton MJ, Kinzer A, Wingate MS, Sen B. Telehealth utilization barriers among Alabama parents of pediatric patients during COVID-19 outbreak. BMC Health Serv Res 2023; 23:693. [PMID: 37370063 DOI: 10.1186/s12913-023-09732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Telehealth can improve access to evidence-based care at a lower cost for patients, especially those living in underserved and remote areas. The barriers to the widespread adoption of telehealth have been well documented in the literature. However, the barriers may not be the same for pediatric patients, who must rely on their parents or guardians to make healthcare decisions. This paper presents some of the leading barriers parents or guardians of pediatric patients report in using telehealth to meet their children's healthcare needs. METHODS This cross-sectional survey was conducted in a tertiary care pediatric Emergency Department (ED) at a children's hospital in Alabama between September 2020 to December 2020. The parents or guardians of pediatric patients were asked about their reasons for not using telehealth despite having healthcare needs for their children, whether they canceled or rescheduled healthcare provider visits and facility visits, and whether the child's health conditions changed over the past three months. Descriptive analyses were conducted that explored the distribution of telehealth use across the variables listed above. RESULTS Five hundred ninety-seven parents or guardians of pediatric patients participated in the survey, and 578 answered the question of whether they used telehealth or not over the past three months. Of them, 33.1% used telehealth, 54.3% did not, and 12.6% did not have healthcare needs for their child. The leading reason for not using telehealth was that the doctor or health provider did not give them a telehealth option, the second main reason was that they did not know what telehealth is, and the third leading reason was that the parents did not think telehealth would help meet healthcare needs for their child. CONCLUSIONS This study highlights the telehealth utilization barriers among underserved pediatric populations, including the need for physicians to proactively offer telehealth options to parents or guardians of pediatric patients. Improving health literacy is of paramount importance, given that a substantial proportion of parents were not familiar with telehealth. Policymakers and healthcare organizations should raise awareness about the benefits of telehealth which can improve healthcare access for underserved pediatric patients.
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Affiliation(s)
- Md Jillur Rahim
- Department of Health Policy & Organization, University of Alabama at Birmingham, 1665 University Blvd, RPHB 330, Birmingham, AL, 35233, USA.
| | - Pallavi Ghosh
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Anne E Brisendine
- Department of Health Policy & Organization, University of Alabama at Birmingham, 1665 University Blvd, RPHB 330, Birmingham, AL, 35233, USA
| | - Nianlan Yang
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, USA
| | - Ryan Roddy
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Mia J Broughton
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Alexis Kinzer
- School of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Martha Slay Wingate
- Department of Health Policy & Organization, University of Alabama at Birmingham, 1665 University Blvd, RPHB 330, Birmingham, AL, 35233, USA
| | - Bisakha Sen
- Department of Health Policy & Organization, University of Alabama at Birmingham, 1665 University Blvd, RPHB 330, Birmingham, AL, 35233, USA
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7
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Ro A, Bruckner TA, Huynh MP, Du S, Young A. Emergency Department Utilization Among Undocumented Latino Patients During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01382-8. [PMID: 35982287 PMCID: PMC9388205 DOI: 10.1007/s40615-022-01382-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
Objective To determine whether Latino undocumented immigrants had a steeper decline in Emergency Department (ED) utilization compared to Latino Medi-Cal patients in a Los Angeles safety-net hospital, March 13, 2020, to May 8, 2020. Study Design The data were extracted from patient medical records for ED visits at LAC + USC Medical Center from January 2018 to September 2020. We analyzed weekly ED encounters among undocumented Latino patients in the nine-week period after COVID was declared a national emergency. We applied time-series routines to identify and remove autocorrelation in ED encounters before examining its relation with the COVID-19 pandemic. We included Latino patients 18 years of age and older who were either on restricted or full-scope Medi-Cal (n = 230,195). Results All low-income Latino patients, regardless of immigration status, experienced a significant decline in ED utilization during the first nine weeks of the pandemic. Undocumented patients, however, experienced an even steeper decline. ED visits for this group fall below expected levels between March 13, 2020, and May 8, 2020 (coef. = − 38.67; 95% CI = − 71.71, − 5.63). When applied to the weekly mean of ED visits, this translates to a 10% reduction below expected levels in ED visits during this time period. Conclusion Undocumented immigrants’ health care utilization was influenced by external events that occurred early in the pandemic, such as strict stay-at-home orders and the public charge rule change. Health care institutions and local policy efforts could work to ensure that hospitals are safer spaces for undocumented immigrants to receive care without immigration concerns.
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Affiliation(s)
- Annie Ro
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Michael Pham Huynh
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine, Los Angeles, CA, USA
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