Pediatric Primary Care Visits Drop & Fluctuate During COVID

PITTSBURGH – Visits to pediatricians dropped substantially—both well-child and sick visits—during the first few months of the COVID-19 pandemic, according to a new study led by a pediatrician-scientist at the University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh. 

And, while well-child visits rebounded as the pandemic wore on, sick visits remained significantly below rates seen in prior years, the researchers reported today in Academic Pediatrics. 

“We set out to describe the visits that children were having with primary care clinicians during the first several months of our experience with COVID-19 in the U.S.,” said senior author Kristin Ray, M.D., M.S., associate professor of pediatrics in Pitt’s School of Medicine. “We looked at the types of primary care visits during the initial weeks of stay-at-home orders as well as how types of visits by children evolved over the subsequent months.”

Unlike other types of clinical practices that had returned to the usual patient volume by the latter part of 2020, pediatric practices were not returning to prior rates, prompting this closer analysis of well-child and problem-focused visits by children.

To better understand this, the research team used claims data from commercially insured children to examine in-person and telemedicine encounters to primary care, asking questions such as which age groups were and were not receiving well-child visits, which types of sick visits were and were not happening at similar rates to prior years, and how immunization rates looked during this period. 

The team found a dramatic decrease in all primary care visits by children during March and April 2020, with well-child visit volume 53% lower than prior years and problem-focused visits 63% lower.

However, these two types of visits diverged in subsequent months. “By September and October 2020, well-child visits were 8% above prior years, which I believe is a testament to how hard primary care practices worked to adapt their clinics and practices to be as safe as possible to continue these essential visits,” said Ray, also a pediatrician and director of health system improvements at UPMC Children’s Community Pediatrics. 

“It is reassuring to see that well-child visit rates recovered by the end of 2020, ensuring that children are now accessing their pediatricians for essential care, immunizations and family support during this challenging year,” said first author Kelsey Schweiberger, M.D., M.S., general academic pediatric fellow, UPMC Children’s Hospital. 

In contrast, in September and October 2020, problem-focused visits remained 31% below prior years. The researchers looked into specific reasons for problem-focused visits and found that visits for virally transmitted conditions, such as acute respiratory tract infections and gastroenteritis, were particularly low compared to prior years. 

“The extensive public health efforts in place to reduce transmission of COVID-19 may have resulted in fewer children becoming ill with these other viral infections,” Schweiberger noted. In contrast, visits for anxiety and depression were higher than in previous years. 

Importantly, even though well-child visit rates in September and October surpassed visit rates during the same time in prior years, there were still sizeable deficits in immunizations received as of the end of the study period compared to prior years.

“Our work complements recent reports about emergency department visits and child hospitalizations during 2020 by describing what occurred for children in the primary care space during these months, which has important implications for child health, for primary care practices that care for children and for the education of pediatric trainees,” added Ray. 

Additional authors on this research are Sadiq Patel, Ph.D., M.S., M.S.W., and Ateev Mehrotra, M.D., M.P.H., both of Harvard University. 

This work was supported in part by a Health Resources and Services Administration NRSA for Primary Care Research Award (T32 HP22240; KS), the National Institute of Mental Health Award Number (T32MH019733; SYP), the National Institute of Allergy and Infectious Diseases (R01AI148159; KNR), and The Commonwealth Fund (AM).

---

PHOTO INFO: (click image for high-res version)