Physician-reported pediatric diabetes virtual visit quality and outcome not associated with social determinants of health

Abstract

Objectives: Social determinants of health (SDH) impact diabetes outcomes. In response to COVID-19, virtual care ensured healthcare access. However, socially disadvantaged groups have less technology access and skills, leading to potential disparities. We assessed the association between SDH and virtual visit success in children living with diabetes.

Methods: We conducted a secondary study of prospectively collected data for children attending a virtual diabetes physician visit from December 1, 2020, to March 31, 2021. Simultaneously, a quality improvement study required physicians to rate visit success indicators, including comparability to in-person visit (same/better/worse) and outcome (successfully/unsuccessfully replaced in-person visit). These data and patient characteristics were extracted from the electronic health record. Postal code-based deprivation indices were used to determine SDH. Statistical analysis tested for the association between deprivation quintiles and virtual visit success.

Results: Data were obtained for 447 children (age 12.7±3.8 years; 52.3% male; 93.1% type 1 diabetes; glucose management indicator 8.0±1.41%). Physicians reported 17.7% worse visits and 13.3% unsuccessful visits. Overall, 20.7% visits were worse or unsuccessful. The odds of having a worse or unsuccessful visit were not different in those with highest versus lowest degree of material deprivation (odds ratio [OR] 1.12, 95% confidence interval [CI] 0.39, 3.20), social deprivation (OR 0.92, 95%CI 0.32, 2.66), or ethnic concentration (OR 0.71, 95%CI 0.29, 1.72).

Conclusion: In our pediatric diabetes population, virtual visit success was not associated with SDH measures, suggesting equitable delivery of virtual care regardless of socioeconomic status. Further studies are required to assess this association in other populations.

Keywords: Digital divide; Health services delivery; Pediatrics; Social determinants of health; Type 1 diabetes; Virtual care.