Pediatric practices across the country are embracing digital technologies, from mobile apps to virtual care, to improve healthcare services provided to their pediatric patients, and their caregivers, and to bridge gaps in healthcare and access to care.
A leading private pediatric practice in Jacksonville, Florida is seeing success with the use of a telehealth platform targeting a particular population of pediatric patients, children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). In the U.S., the number of diagnoses of attention deficit disorder (ADHD or ADD) in the United States skyrocketed 43 percent between 2003 and 2011, bringing the total number of American children who had ever received an ADHD diagnosis to 6.1 million, or approximately 9.4 percent of U.S. children ages 2 to 17, according to 2015 statistics from the Center for Disease Control and Prevention (CDC). Of children with current ADHD, almost two thirds (62 percent) were taking medication and slightly less than half (46 percent) had received behavioral treatment for ADHD in the past year, according to the CDC data.
For pediatricians, it is important to schedule frequent medical visits and follow-up appointments with children diagnosed with ADHD to ensure their diagnosis remains accurate and that any related learning disabilities or mood problems are identified. “It’s a fluid diagnosis. It’s not just about starting medication, we need to see how that’s implemented, what kind of behavioral changes the child might be experiencing, if they are getting all the services that they need at school, any side effects of the medications and how compliant the kids are with their treatments, because they tend to be forgetful, and a lot of the times the parents tend to forget as well,” Prasanthi Reddy, M.D., founder and CEO of Rainbow Pediatric Center and the organization’s medical director, says. “By touching base more frequently, we’re able to reinforce the diagnosis and the prognosis as well as ongoing treatment changes that we need to implement.”
Established in 2004, Rainbow Pediatric Center has seven providers serving patients at two locations in Northeast Florida, a practice in Jacksonville and one in Ponte Vedra. Rainbow Pediatric has been designate a National Committee for Quality Assurance (NCQA) Level 3 Patient-Centered Medical Home (PCMH). “Our practice is known in the community for having a good reputation, and we’re recognized by payers and patients alike for providing quality healthcare. We’re known for having less ER rates, by keeping our doors open on holidays and weekends, so we work diligently at bridging the gaps in healthcare for our patients and being a true medical home,” Reddy says.
With regard to the practice’s ADHD patients, Reddy and her colleagues recognized that close follow-up with patients yielded better outcomes. However, the practice leaders also found that some parents were having difficulty getting children to regular appointments. Parents were unwilling to pull their children out of school for frequent check-ups and physicians were limited to the number of children they could see during after-school hours, Reddy notes.
“The challenge is that in order to do that close follow-up, we need to see these kids at least monthly or every other month. It’s difficult for families to pull kids out of school, especially ones who are already having difficulties and challenges in school due to their ADHD or other conditions. And we’re asking parents to take time out of work to bring the kids in during these visits. It was a big barrier to care,” Reddy says. “Parents were willing to bring kids in once every three months, but we felt that wasn’t enough of a follow-up to really make a dent as far as treatment.”
Prasanthi Reddy, M.D.
To address these gaps in care, Rainbow Pediatric Center last year worked with its electronic medical record (EMR) vendor, eClinicalWorks, to implement a telemedicine pilot program to offer tele-visits specifically for patients with ADHD and their caregivers. The goal, Reddy says, was to improve access to care while maintaining the practice’s high standards of care. Initially, 150 pediatric patients and their families participated in the telemedicine pilot program.
Prior to the telemedicine pilot, the compliance rate for ADHD patients showing up for their one-month follow-up appointment was about 40 percent. Since the implementation of the telemedicine platform, appointment compliance among ADHD patients is now 71 percent, according to Reddy, representing a 77 percent increase. Additionally, offering patients and their families tele-visits has helped to improve patient engagement, Reddy notes.
“When we did these tele-visits, the parents were excited about doing it this way because we were offering them after-hours, so their kids did not have to be pulled out of school and we were able to do the telehealth visit wherever the families were, so they would do tele-visits with their doctor from their car before the child went to the soccer game, or at the kitchen table. The parents and patients really enjoyed it,” Reddy says. “The parents were eager to make sure that we implemented that as a regular service as opposed to just a pilot program.”