Pittsburgh—Telemedicine might be an innovative way to help patients conveniently get the care they need, but a new study suggests it increases antibiotic prescriptions in children with acute respiratory infections (ARIs).

A report in Pediatrics notes that young patients were prescribed antibiotics more often during direct-to-consumer (DTC) telemedicine visits than during in-person primary-care appointments or urgent-care visits.

“In recent years, the use of telemedicine for acute, primary care concerns has increased among children,” explained lead author Kristin Ray, MD, MS, a pediatrician at Children’s Hospital of Pittsburgh. “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.”

To find out more, researchers looked at information from a large, national health plan database that covers more than 4 million children in the United States annually and contracts with a DTC telemedicine vendor. Antibiotic prescribing for ARIs among pediatric DTC telemedicine visits were compared with visits at primary-care offices and urgent-care centers, which were matched by age, state, diagnosis, and other variables.

Overall, 4,604 DTC telemedicine, 38,408 urgent care, and 485,201 primary care provider (PCP) visits for ARIs were reviewed. Results indicate that antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits vs. 42% urgent-care and 31% PCP visits; P <.001 for both comparisons).

In addition, guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits vs. 67% urgent-care and 78% PCP visits; P <.001 for both comparisons), the researchers determined.

“At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits,” study authors concluded.

The issue might be unique to children, however. Ray points out that differences in antibiotic prescribing found in the pediatric analysis were much larger than those found in similar analyses of DTC telemedicine visits by adults.

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