Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic.

Context: The COVID-19 pandemic has impacted the volume and nature of pediatric primary care visits nationwide. Objective: This study aimed to identify trends in pediatric visits during COVID-19 at our institution to reveal challenges and opportunities to improve care. Study Design: Retrospective chart review of all pediatric visits from January 1, 2019 through September 30, 2021 using the electronic health record (EHR). Descriptive statistics were used for data analysis. Setting or Dataset: Single family medicine clinic within a large academic medical center in Northern California. Data collected for each pediatric primary care visit included age, sex, type of visit (preventive or problem-focused), reason for visit (if problem-focused), and mode of visit (in-person or video). Population Studied: Pediatric patients (<18 years old). Intervention/Instrument: N/A Outcome Measures: Volume and nature of pediatric primary care visits. Results: A total of 4,846 pediatric visits occurred during the study period. Visit volume dropped 9% from 2019- 2020, mostly during April-May 2020, and recovered afterward to pre-pandemic baseline through 2021. There were no significant changes to age, sex, or type of visit during the study period with one exception: the proportion of problem-focused visits increased 23% (p=0.004) from 2019-2021 in adolescents aged 12-<18, driven largely by a 107% increase (p<0.001) in the proportion of behavioral health visits (14% in 2019, 18% in 2020, and 29% in 2021). Video visits accounted for 4% of all visits in 2019, 39% in 2020, and 35% in 2021. Video visit volume decreased from 2020-2021 in all age categories except for adolescents aged 12-<18, which remained stable at 43% of all visits. Conclusions: A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for children and adolescents now and in the post-pandemic era.