189 - Comparisons of Rural and Urban Pediatric Clinicians’ Perspectives on School-based Telemedicine to Optimize Care

Publication Number: 4186.189

Haley Strouf Motley, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Kristin Ray, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Kelsey Schweiberger, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Christine A. March, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Elizabeth Miller, National Center for Child Health and Development, Tokyo, Japan, Pittsburgh, PA, United States; Jacquelin Rankine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Background: School-based health centers (SBHCs) can improve access to care but have limited reach. School-based telemedicine (SBT) may extend school health services, particularly in rural or under-resourced communities where SBHCs are not feasible.

Objective: Characterize pediatric clinicians’ perspectives on SBT benefits and barriers across geographic settings.

Design/Methods: Pediatric clinicians in Pennsylvania completed an online survey via professional listservs. Clinicians were asked to consider live interactive SBT in which they provided care from their typical clinical setting to a patient at school. Items assessed prioritization of SBT (1=not a priority, 4=high priority); perceived impact on child health, educational outcomes, and clinician work experience (1=much worse, 5=much better); and potential barriers to SBT (1=not a barrier, 3=major barrier). Rural-urban comparisons were performed using Wilcoxon rank-sum tests.

Results: Participants (N=210) were mainly Non-Hispanic White (81%), female (80%), primary care providers (87%), and in urban settings (77%). Overall, 52% rated SBT as medium-priority and 19% as high-priority as a strategy to improve child health. Rural clinicians were less likely to assign SBT medium- or high-priority (59% vs 75%, p=0.01). Participants anticipated benefits for child health (M=3.81, SD=0.67) and education (M=3.82, SD=0.62) with minimal impact on clinician work experience (M=2.98, SD=0.79). Rural clinicians expected fewer educational benefits (M=3.61 vs M=3.88, p=0.01) and worsened clinician work experience (M=2.77 vs M=3.04, p=0.03). Perceived barriers included start-up costs (53%), lack of usefulness (54%), lack of guidelines for use (67%), poor ability to integrate into workflow (76%), insufficient time (78%), disrupted patient-provider continuity (88%), legal concerns about information sharing (89%), and financial viability (89%). Rural clinicians were more likely to perceive start-up costs (87% vs 49%, p=0.05), legal concerns about information sharing (96% vs 87%, p=0.01), and lack of usefulness (71% vs 50%, p=0.01) as barriers.

Conclusion(s): Pediatric clinicians saw benefits of SBT to child health and education and did not anticipate impact on clinician work experience. However, barriers remain to successful implementation, particularly financial viability, concerns about information sharing, disruptions in continuity, and time and workflow constraints. Rural clinicians perceived less benefit and greater barriers than urban clinicians, suggesting a need for geographically tailored strategies to optimize SBT feasibility and uptake.