Kids get antibiotics more often via telemedicine

Children receive antibiotic prescriptions more often during telemedicine visits than during in-person primary care or urgent care visits, according to a new study.

“In recent years, the use of telemedicine for acute, primary care concerns has increased among children,” says lead author Kristin Ray, assistant professor of pediatrics at the University of Pittsburgh School of Medicine.

“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.”

For the study, which appears in Pediatrics, 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.

Researchers 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. The comparisons matched for age, state, diagnosis, and other variables.

The analysis revealed that children received antibiotic prescriptions during 52 percent of telemedicine visits, compared with 42 percent of urgent care, and 31 percent of primary care provider visits.

Further, compared with primary care and urgent care visits, the antibiotics received at telemedicine visits were less likely to be consistent with clinical guidelines. The use of unnecessary antibiotics or those broader than necessary may result in side effects and contribute to antibiotic resistance, researchers say.

“Insurers are increasingly offering telemedicine—with 96 percent 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,” Ray says.

“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.”

The differences in antibiotic prescribing found in the new study surpassed differences found in similar analyses of direct-to-consumer telemedicine visits by adults, Ray says. 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, she says.

Additional authors are from Harvard University, Boston Children’s Hospital, and Brigham and Women’s Hospital. The National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health & Human Development supported the work.

Source: University of Pittsburgh