120 - Impact of the COVID-19 Era on Preventative Primary Care for Children 0-5 years old

The COVID-19 pandemic has resulted in widespread disruptions to primary care delivery and shifts to virtual care, but the extent to which it has affected access to preventative primary care for children 0-5 years old remains unclear.

Objective:

Characterize the impact of the COVID-19 era on preventative primary care for children ages 0-5 years old and understand the impact on child development and health-related outcomes.

Design/Methods:

Scoping review searching 5 electronic databases (June to September 2022). We included studies of children 0-5 years old related to primary care in the COVID-19 era.

Results:

A total of 56 studies were included, most of which were qualitative in nature (n=30) and conducted in the US (n=29), UK (n=7), Canada (n=3), and other countries (n=17). Of the quantitative studies, sample sizes ranged from 71 to 5.4 million, and the study start dates ranged throughout the pandemic, from the beginning in March 2020 to June 2022. All included studies addressed appointment attendance and referrals (n=24), child development (n=21), or other health related outcomes (n=11). There were drastic changes in attendance for in-person and virtual visits and referrals, with largest declines in in-person preventative care visits in the initial 9 months of the pandemic with visits rebounding in 2021. There was a large rise in virtual visits as practices adapted to stay-at-home orders. Children with low parental education, lower socioeconomic status, and migrant status were at greater risk for delays in preventative primary care. Having increasing numbers of children at home and children who had recent telehealth appointments were associated with more delays in preventative services. COVID-19 impacted child development notably by worsening mental and behavioural outcomes. Compared with historical cohorts, one-year-old children assessed in 2020 were at greater risk of neurodevelopmental and communication delays, and infants born to mothers with COVID-19 infections in their first and second trimesters were more likely to have developmental delays. Although several studies implied a link between changes in primary care utilization and its effect on child development and other health-related outcomes, no studies studied this directly.

Conclusion(s):

The COVID-19 pandemic greatly impacted preventative primary care visit attendance, delivery, as well as child development and other health outcomes. Further research should focus on studying the long-term impact of COVID-19-related preventative care visit changes and its impact on child outcomes.