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Study: Children prescribed unnecessary antibiotics by commercial telemedicine providers :

April 8, 2019


Children treated for respiratory infections by a commercial telemedicine provider are more likely to be prescribed antibiotics than in other settings.

Those prescriptions also are more likely to run counter to antibiotic guidelines, according to “Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits” (Ray KN, et al. Pediatrics. April 8, 2019,

As visits to direct-to-consumer (DTC) telemedicine continue to grow, researchers set out to look more closely at the quality of care patients receive. They focused on acute respiratory infections because of their frequency.

Using 2015-’16 insurance claim data for children, they matched telemedicine visits to urgent care and primary care using demographic and diagnostic information.

Results showed 52% of children received an antibiotic from a telemedicine provider compared to 42% at urgent care and 31% from a primary care provider.

Among the telemedicine group, about 59% of the prescriptions followed guidelines for antibiotic management, often deviating by prescribing antibiotics for viral illnesses. About 67% of urgent care providers and 78% of primary care providers followed antibiotics guidelines.

Just 4% of children who were diagnosed with streptococcal pharyngitis had a streptococcal test, compared with 75% of those going to urgent care and 68% in primary care, according to the study.

Authors noted patients receiving care via DTC telemedicine typically rely on phones or computers that lack special equipment to help the provider diagnose the illness and may vary in quality.

“These issues reduce the data available to the treating DTC telemedicine provider, which may be of greater concern in pediatric care because of the more limited availability of children to communicate symptoms,” authors wrote.

They also noted DTC telemedicine providers may not have a previous relationship with the patient, the ability to see their full medical history or pediatric training.

“Professional groups such as the American Academy of Pediatrics and the American Telemedicine Association have previously raised concerns about DTC telemedicine care outside of the medical home for pediatric patients,” authors wrote. “Our results support these concerns and underscore the importance of pediatric-specific evaluation and guidelines.”

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