1164-P: Evaluating the Impact of Telemedicine Expansion on Access to Care for Oregon's Pediatric Type 1 Diabetes Population

Background: Type 1 Diabetes (T1D) has a higher incidence in low density areas but only 1.8% of US pediatric endocrinologists are located in rural areas. The telemedicine expansion (TE) that accompanied the COVID-19 pandemic presents a novel opportunity to increase access to care for rural-residing children with T1D who may live a great distance from their provider.

Purpose: The study objective was to compare trends in visit frequency amongst our region's pediatric T1D population before and after TE by those living <100 miles versus ≥100 miles from clinic (MFC) and those residing in urban versus rural areas.

Methods: We evaluated EHR data from 790 children receiving care between July 2018 - December 2021. We estimated differences in likelihood of adequately-timed monitoring care (ATMC) over time by patient CCS status using Generalized Estimating Equations.

Results: Just prior to TE, those living ≥100 MFC were 20.6% less likely to receive ATMC compared to those living <100 MFC (RR 0.79; 95% CI: 0.57, 1.11). Following TE, likelihood of ATMC decreased from 31.0% to 24.0% in those living ≥100 MFC and decreased from 39.0% to 25.9% in those living <100 MFC; 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 prior to TE, those living in rural areas were 0.1% less likely to receive ATMC (RR 1.00; 95% CI: 0.61, 1.63) compared to those living in urban areas. Following TE, likelihood of ATMC decreased from 37.2% to 20.2% in those living in rural areas and decreased from 37.3% to 25.7% in those living in urban areas; 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 were more substantial for those living <100 MFC and/or in rural areas, however, these discrepancies were not statistically significant.