With closures in hospital pediatric in-patient units rising and with many communities in a “medical desert,” pediatricians need to think creatively to care for children, especially those dependent on technology for daily living. By utilizing telemedicine and understanding the risks of travel and social determinants of health, pediatricians can help connect families to the most appropriate care while closing gaps to accessible healthcare.
Triaging Care for Patients with Assistive Technologies
Children with technology dependence (CTD) need medical technology to sustain their quality of life and daily living. Examples include children requiring a tracheostomy, gastrostomy, or intraventricular shunt. While many patients may face circumstances requiring a high-level of hospital or intensive care, CTD experts say telemedicine and local pediatric care can address issues. Pediatricians have a key role in guiding families through triage in each instance.
“When patients have more complex problems or greater financial resources, they may bypass closer hospitals to attend larger hospitals farther away… However, at some point, concentration in pediatric hospital services may effectively create barriers that eliminate choice.” Drs. Heidi Kloster and Ryan Coller from the University of Wisconsin
Social determinants of health, including financial stability and housing, make it more difficult for certain communities, such as rural ones, to access high-level hospitalist care for patients with CTD. Commentary by Drs. Heidi Kloster and Ryan Coller from the University of Wisconsin note that patients are more likely to bypass smaller centers of care or those deemed “lower quality” in favor of larger centers, such as a city children’s hospital.
When families are met with this choice, travel, costs, and risks to the patient all become factors in decision-making. This is exactly where the primary care pediatrician can help. Triaging care through local medical homes, telemedicine, and a higher-level care team collaborating with physicians can create a foundational network that supports each patient’s needs.
Telemedicine for CTD
Telemedicine can help pediatricians overcome the geographic challenges of caring for CTD patients. By video conferencing, doctors can remotely monitor patients and provide healthcare to rural areas and families lacking access to medical care. The right telemedicine for your pediatric practice will vary based on your needs, but it will need to be HIPAA-compliant, user-friendly for families and staff, and can ideally match with other practice tools such as your EHR.
Telemedicine can be a great choice for low-level issues where travel is a concern for a CTD patient, providing reassurance and guidance from the safety and comfort of the family’s home or the child’s school. For example, a pediatrician could guide a school nurse or parent through changing a tracheostomy tube, which is recommended to be changed every 30 days.
Local or Intensive Care?
In a study released in Pediatrics in May 2023, most CTD encounters occurred four times further away in distance than the closest facility available.
Where conditions are time-sensitive, families should not feel the need to weigh the risk of traveling to a further medical facility if their local pediatrician or a closer specialist can help. Medical homes have a key role in identifying with families the options for fast and efficient care in emergency situations that would be able to best care for a child’s needs.
The May 2023 Pediatrics study offers suggestions for communities and systems of care that would benefit CTD patients. This could include partnering with EMS providers for coordinated transport across facilities, especially those professionals with pediatric expertise; partnering pediatric with community hospitals for education, training, and collaboration; and finally, recognizing social determinants of health to influence future healthcare infrastructure and planning.
The best care for patients with assistive technology may only sometimes be the largest hospital, whether 10 minutes or 10 hours away. With a supportive medical home, these patients depend on a network of healthcare providers and support services that ensure they are seen promptly, efficiently, and by the most appropriate medical facilities. The AAP recommends sharing their commentary to help your community begin or build upon the important work required for collaborative, supportive healthcare systems for all children.