Practices using telehealth during pandemic followed antibiotic guidelines

• Ray KN, et al. Acad Pediatr.https://bit.ly/3w9AEnG.

Pediatricians who diagnosed patients with acute respiratory tract infections (ARTIs) via telemedicine in the early months of the pandemic consistently followed clinical guidelines for antibiotic use, according to a study of 47 pediatric practices.

Prior to the pandemic, few primary care pediatric practices conducted telemedicine visits, and patients increasingly sought care from commercial providers, especially for ARTIs. Studies have shown that antibiotics often are prescribed unnecessarily for ARTIs during these visits.

When telemedicine visits ramped up during the pandemic, investigators saw an opportunity to look at antibiotic prescribing for ARTIs by primary care pediatricians. They analyzed a large primary care network’s electronic health record data from April through September 2020. All of the practices were certified medical homes that participated in ongoing antibiotic stewardship efforts.

Researchers also looked at the proportion of patients diagnosed with acute otitis media (AOM) or streptococcal pharyngitis via telemedicine, since clinicians did not have access to tele-otoscopy or remote strep testing.

During the six-month pandemic period, 36% of 8,332 ARTI visits were conducted via telemedicine. Nearly 93% of these visits adhered to antibiotic prescribing guidelines vs. about 91% of in-person visits.

Improvements in both diagnosis and management via telemedicine were seen over time. Visits for sinusitis and viral ARTI that followed antibiotic prescribing guidelines increased from 88% in April to 97% in September. Diagnoses for AOM or strep throat declined from 52% of telemedicine ARTI visits in May to 7% in September.

“ … our results illustrate that a primary care network with active antibiotic stewardship can achieve and maintain highly guideline-concordant antibiotic management for ARTIs through telemedicine,” the authors concluded.