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Kids are prescribed more antibiotics with telemedicine
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A study published in Pediatrics revealed that children with acute respiratory infections who are treated through direct-to-consumer telemedicine visits are significantly more likely to receive antibiotics. These children, according to the researchers, are also less likely to receive guideline-based antimicrobial treatment.
Kristin N. Ray, MD, MS, assistant professor of pediatrics at the University of Pittsburgh School of Medicine, told Infectious Diseases in Children that the findings show that antimicrobial stewardship should be a priority for telemedicine programs that treat acute pediatric illnesses.
The AAP recommends against using direct-to-consumer (DTC) telemedicine outside the medical home for acute care because of limited physical exam capabilities, a lack of patient-provider relationships, and a lack of access to all patient records. Additionally, the academy raised concerns about children’s ability to verbalize their symptoms.
The researchers conducted a retrospective cohort study using claims data collected from a large national commercial health plan. Children aged 0 to 17 years who presented with an acute respiratory infection, or ARI, were included in the analysis if they had no other comorbidities that could affect antibiotic prescribing.
Primary care was the most frequently used type of health care sought for pediatric ARIs (n = 485,201), followed by urgent care (n = 38,408) and DTC telemedicine (n = 4,604). Children with ARIs who used DTC telemedicine were prescribed antibiotics more often (52%) compared with those who used urgent care (42%; P < .001) and primary care (31%; P < .001).
Moreover, children who had DTC telemedicine visits were less likely to receive guideline-based antibiotic management (59%) compared with those visiting primary care (78%; P < .001) or urgent care (67%; P < .001).
The researchers wrote that these findings contrast with previous studies related to DTC telemedicine quality, which included adult patients.
“As a parent, I understand the desire for care that can be accessed from home, but we need to make sure that the care being delivered to children remains high quality,” Ray said. “It is worth ongoing reflection on which diagnoses and symptoms can and cannot be well managed through telemedicine, and the answers may be different for children than for adults, and they may also be different for telemedicine in the home vs. telemedicine in a health care facility. I think applying antibiotic stewardship approaches to programs and to individual physicians to guide ongoing improvement is important for any setting where children receive acute care.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Javeed Siddiqui, MD, MPH
Antibiotic resistance continues to be a growing concern throughout the world. Every practitioner, no matter the setting, has a role in either curtailing or contributing to bacterial resistance.
The data presented by Ray and colleagues indicates that DTC telemedicine resulted in higher rates of antimicrobial prescribing compared with urgent care or primary care settings.
DTC telemedicine has always carried the risk for incomplete care and over-prescribing. Those concerns are substantiated by this study.
We cannot ignore these data, but it would be wrong to interpret them as a blanket judgement on telemedicine. Rather, we must accept these data, and DTC telemedicine companies must allow for increased transparency while continuing to focus on quality of care. These data warrant us to pause and further evaluate the issue of the over-prescribing of antimicrobials. Otherwise, we will have missed an important opportunity to address the key issues of access to care and the value of technology in medical care delivery.
Telemedicine is gaining momentum but it is still an emerging field. Those of us in telemedicine must be cognizant of the value of quality. Quality needs to be an overarching basis upon building a successful telemedicine program.
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