Adolescent and Caregiver Attitudes Towards Telemedicine Use in Pediatric Nephrology

Abstract Background: Telemedicine is increasingly utilized as an alternative to in person consultation. Current pandemic conditions are providing additional impetus to virtual care delivery. We aimed at comparing both pediatric patient and caregiver attitudes towards telemedicine (here as tertiary center to remote health care location) as a crucial determinant of longer-term effectiveness. Methods: This mixed methods cohort study combined patient characteristics and analysis of transcribed structured telephone interviews with both pediatric nephrology patients (11-18 years) and their caregivers. Results: For 11 child-parent dyads, the median distances to tertiary center were 191 km (range 110-1378 km) and 1 km (1-54 km) to remote telemedicine location. Overall a ratio of 2:1 for telemedicine to in-person visits was favored; with caregivers more in favor of remote care than patients. Qualitative analysis found that experiences with telemedicine were distinguished by consultation-specific factors and contextual factors. Contextual factors (travel/cost savings) were valued for telemedicine by patients and caregivers. Consultation-specific factors, such as the ability to show the doctor physical symptoms, were more valued during in-person consultations, especially by patients. The overall visit type preference was related to the nature of the consultation. For regular check-ups, and for patients with less complex needs, participants felt that telemedicine offered a comparable experience to in-person visits. Conclusions: Indiscriminate transfer to chronic care predicated on mainly telemedicine approach is not compatible with user expressed attitudes (especially patients). Accurately mapping models of care to these attitudes is an essential determinant of effective management and longer-term engagement with potentially life-long health challenges.