Improving Access to Care with Telehealth Physiatry Visits for Children with Special Healthcare Needs

California lacks enough pediatric physiatrists to meet needs

The California Children’s Services Medical Therapy Program, a network of multidisciplinary school-based care clinics, provides comprehensive medical care to nearly 23,000 children with special healthcare needs, including those with cerebral palsy, spina bifida, and traumatic brain and spinal cord injuries. During doctor’s visits, physiatrists—physicians that treat conditions of the bones, muscles, joints, brain, and nervous system that can affect other systems of the body—guide physical and occupational rehabilitation therapies, recommend medical equipment, and identify children who may need surgical interventions, among other services to reduce limitations of the child’s ability to function.

In California, as well as in other states, a shortage of physiatrists presents a barrier to care for children in rural communities. Insurance companies tend to balk at paying for the time needed for physiatrists to travel to rural communities, which in California can be 100 miles or more from the physiatrist’s original location.

Too often, rural families of children with special physical needs must choose between traveling long distances to seek care or forgoing care, according to Dr. Loren T. Davidson, a clinical sciences professor and physician at UC Davis Health. “In rural communities, the likelihood that [these kids] are going to see a pediatric rehabilitation doctor, a physiatrist, is based upon the distance that they live from a special care center or tertiary care medical center.”

Researchers examined the effectiveness of telehealth exams

Dr. Davidson and Dr. James Marcin, a pediatric critical care physician and telehealth expert, studied the effectiveness of telehealth appointments to provide care for children with cerebral palsy. Originally, the study was designed to compare traditional in-person physiatrist visits with a hybrid visit, where physiatrists led the exam remotely, while an in-person physical therapist conducted the physical exam. For the hybrid visits, physiatrists outlined what would happen in the exam with the therapists, and cameras provided additional information for physiatrists to assess physical movement. However, when the COVID-19 pandemic curtailed access to in person visits, a fully virtual visit was added, where parents led the physical exam with direction from the providers, while physical therapists and physiatrists both observed.

Hybrid exams are viable alternatives to in-person physiatry exams

Researchers found no differences between the parent experience and parent satisfaction with the quality of care across the three different care models. The physiatrists and therapists preferred the in-person and hybrid models of care, rating confidence in quality of care and parent education lower for the all-virtual model of care compared with the other two care models. However, physiatrists and therapists were equally satisfied with the quality of care for both the in-person and hybrid visits. They also estimated that the hybrid visits would save $100 per visit, on average, by reducing travel costs for physiatrists.

The experiment showed that hybrid visits may provide an important way to stretch the finite resources of physiatry in the state and other rural areas throughout the country by providing a cost-effective and patient-centered model of care as an alternative to in-person care.

“This study demonstrated that a hybrid model of care could be used to expand access to pediatric physiatry care in California and, potentially, around the nation. These findings are important and relevant for regions where few pediatric physiatrists serve geographically large areas and access to specialty care may be limited.” – Dr. James Marcin