Impact of the COVID-19 Pandemic on Attendance at the 18-month-old Developmental Screening Visit

Context: The COVID-19 pandemic disrupted primary care services but its impact on the care of young children remains unclear. The 18-month-old visit is a crucial preventive care visit where primary care providers conduct screening to detect potential developmental delays and areas of concern.

Objectives: 1) To determine changes in attendance at the 18-month-old well child visit between pre-COVID and COVID eras; 2) To determine whether these changes differ by health equity stratifiers (sex, rurality, neighbourhood income, neighbourhood material deprivation, and ethnic concentration).

Study Design and Analysis: Longitudinal cohort study. We used an interrupted time-series approach and fitted a segmented linear regression model. We estimated the level-change and slope change of preventive visit rates, comparing pre-COVID to COVID months and adjusting for seasonality and trends over time.

Setting or Dataset: Electronic Medical Record data from primary care clinics in the University of Toronto Practice Based-Research Network (UTOPIAN) Data Safe Haven (Ontario, Canada).

Population Studied: Children 17 to 24 months old.

Intervention: The pre-COVID era was defined as March 2015-February 2020 and COVID era March 2020- March 2022.

Outcome Measures: The 18-month-old enhanced developmental preventive care visit (in-person or virtual) was identified using billing data from UTOPIAN. Health equity stratifiers were determined using Statistics Canada data and postal codes.

Results: Of the 29,942 children in the cohort, 51% were male. Proportions of children across income quintiles were approximately equal (highest to lowest: 22%, 20%, 18%, 17%, 23%). Virtual visit rates were 0% pre-COVID and 16%, 10%, and 3% in 2020, 2021, and 2022, respectively. In the pre-COVID era, there was a small positive trend of 18-month visit rates increasing over time (ß = 0.04, 95% CI: 0.02- 0.05). At the start of the pandemic, there was a level change in the rate of 18-month visits (ß = -1.10; 95% CI: -2.10 to -0.10). A marked drop in visits was observed for the months of March and April 2020. However, there was no significant difference in trends for the 18-month visits in the pre-COVID and COVID-era and no evidence of moderation by health equity stratifiers.

Conclusion: Despite a drop in the 18-month visits at the onset of the pandemic, the overall trend in visits was not statistically different between the pre-COVID and COVID eras. Health equity stratifiers did not moderate the association.