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Telemedicine Visits May Increase Antibiotic Overprescribing

April 9, 2019
Children with acute respiratory infections were prescribed antibiotics more often during direct-to-consumer telemedicine visits than during in-person primary care appointments or urgent care visits, according to UPMC Children’s Hospital of Pittsburgh research reported in Pediatrics.
“In recent years, the use of telemedicine for acute, primary care concerns has increased among children,” said lead author Kristin Ray, MD, MS, pediatrician, Division of General Academic Pediatrics, UPMC Children’s Hospital. “We know very little about the care children receive during these direct-to-consumer telemedicine visits, which occur with doctors outside of the child’s usual pediatric office.”
The researchers examined a large, national health plan database that covers more than 4 million children in the United States annually and contracts with a direct-to-consumer telemedicine vendor. The team compared antibiotic prescribing for acute respiratory infections among pediatric direct-to-consumer telemedicine visits compared to visits at primary care offices and urgent care centers which were matched by age, state, diagnosis and other variables. 
The analysis revealed that children received antibiotic prescriptions during 52% of telemedicine visits, compared with 42% of urgent care and 31% of primary care provider visits. Compared to primary care and urgent care visits, the antibiotics received at telemedicine visits also were less likely to be consistent with clinical guidelines. The use of antibiotics that are not necessary or that are broader than necessary may result in side effects and contribute to antibiotic resistance. 
“Insurers are increasingly offering telemedicine – with 96% of large business insurance plans now offering coverage – and as a result, millions of children now have access, and our prior work found that use is rapidly increasing,” added Ray, also assistant professor of pediatrics, University of Pittsburgh School of Medicine.
“As a general pediatrician, I’m interested in making care easier and less burdensome for families, and I think there are many technological innovations that aim to do this, but I think it also is important to make sure the quality of the care that children receive remains high,” Ray said.
According to Ray, these differences in antibiotic prescribing found in this analysis were much larger than differences found in similar analyses of direct-to-consumer telemedicine visits by adults. This underscores the need for pediatric-specific analyses of health system innovations to make sure we understand the impact of new methods of health care delivery not just for adults, but also specifically for children.
Research reported in this publication was supported by National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health & Human Development grant K23HD088642. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Additional authors on the study are Zhuo Shi, BA, Harvard University; Courtney A. Gidengil, MD, MPH, RAND Corp. and Boston Children’s Hospital; Sabrina Poon, MD, Brigham and Women’s Hospital; Lori Uscher-Pines, PhD, MSc, RAND Corp.; and Ateev Mehrotra, MD, MPH, Harvard University and Beth Israel Deaconess Medical Center.