Pediatrics: Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits

7 August, 2019

"A study of more than 12,000 telemedicine encounters involving children with respiratory ailments has found that antibiotics were prescribed in more than half of the visits, and that patient satisfaction was strongly linked to receiving an antibiotic."

The full text is restricted access. The above extract is drawn from an article by the Center for Infectious Disease Research and Policy which provides a useful overview:

Citation and abstract (video and text):

PEDIATRICS Vol. 143 No. 5 May 01, 2019

e20182491 doi: 10.1542/peds.2018-2491 

Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits

Kristin N. Ray, Zhuo Shi, Courtney A. Gidengil, Sabrina J. Poon, Lori Uscher-Pines, Ateev Mehrotra

VIDEO ABSTRACT: (may not play in some browsers)


BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office.

METHODS: In a retrospective cohort study using 2015–2016 claims data from a large national commercial health plan, we identified ARI visits by children (0–17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.

RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons).

CONCLUSIONS: 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

Martin Carroll

Independent Consultant (Global Health)  

CHIFA PROFILE: Martin Carroll has worked on issues affecting health in LMICs for over fifteen years. Whilst at the British Medical Association, he led a major project, funded by DfID, to develop the organisation's role as a leading advocate for improving health in LMICs, which it continues to hold today. He has worked with HIFA since 2008 and is a member of the HIFA Steering Group and the following HIFA Working Groups: Fundraising, Multilingualism and Social Media. He is also the author of the monthly HIFA Blog. martinmichaelcarroll(at)iCloud(dot)com Twitter: @MMCarroll Website: martinmcarroll(dot)com