Evaluating the Impact of Telemedicine Expansion on Visit Frequency for Children with Type 1 Diabetes at a Single Academic Center in Oregon

Objective: The telemedicine expansion (TE) that accompanied the COVID-19 pandemic presents a novel opportunity to increase access to care for rural-residing children with type 1 diabetes (T1D) who may live a great distance from their provider. The study objective was to compare trends in visit frequency among the pediatric T1D population at a single academic center in Oregon before and after TE by those living <100 miles versus ‡100 miles from clinic (MFC) and those residing in urban versus rural areas. Research Design and Methods: We evaluated electronic health record data from 790 children receiving care between July 2018 and December 2021. We estimated differences in likelihood of adequately timed monitoring care (ATMC) over time by patient residence using Generalized Estimating Equations. Results: Just before TE, 37.3% of children were receiving ATMC and those living ‡100 MFC were 20.6% less likely to receive ATMC compared with those living <100 MFC (relative risk [RR] 0.79; confidence interval [95% CI]: 0.57-1.11). Following TE, decreases in ATMC for those living ‡100 MFC were less than for those living <100 MFC (RR of interaction: 1.17; 95% CI: 0.68-2.00). Just before TE, those living in rural areas were as likely to receive ATMC compared with those living in urban areas (RR 1.00; 95% CI: 0.61-1.63). Following TE, decreases in ATMC were greater for those living in rural areas versus urban areas (RR of interaction: 0.79; 95% CI: 0.31-2.01). Conclusions: Between July 2020 and December 2021, the likelihood of ATMC decreased across the entire pediatric T1D population. Decreases in ATMC during this period were more substantial for those living <100 MFC and/or in rural areas, however, these discrepancies were not statistically significant.