The era of smart devices has brought with it the era of telehealth whereby with the touch of an app, you can gain access to a pediatric clinician and receive medical advice without going to your child’s medical home or even the urgent care center or emergency department nearby. Such visits are often time savers, not to mention many telemedicine consults are reimbursable. Yet adult studies note that telemedicine consults are more apt to result in antibiotic prescriptions for adults than one might get from one’s adult primary care provider or even from an urgent care center. Does the same risk of poor antibiotic stewardship apply when children’s health issues are discussed using direct-to-consumer (DTC) telemedicine? Ray et al. (10.1542/peds.2018-2491) investigated this question by performing a retrospective cohort study using claims data from one national commercial health plan and specifically looked at acute respiratory infections (ARIs) to see how often antibiotics were prescribed or antibiotic stewardship guidelines were used as the basis for the prescription. The authors reviewed more than 4600 DTC consults, 38,000 urgent care visits, and 485,000 primary care visits for ARIs and found that antibiotic prescribing was significantly higher for DTC consults (52%) than urgent care (42%) and primary care (31%) visits. Antibiotic guideline concordance was also significantly lower with DTC visits (59%) compared to urgent care (67%) and primary care visits (78%).
So should parents avoid DTC telemedicine visits which, as these various online sites increase in number, is easier said than done? To answer this question, we asked Dr. Jeffrey Gerber from the Children’s Hospital of Philadelphia to share his thoughts in an accompanying commentary (10.1542/peds.2019-0631). Dr. Gerber notes the limitations of this study (e.g., only one vendor, a little over 1% of all the ARIs captured in this study used DTC telemedicine). But as Dr. Gerber points out, since ear infections, sore throats, and even sinus infections are largely viral, DTC should at best be a screening vehicle to determine if an actual office visit is warranted and not a primary source for prescribing antibiotics for an ARI. This study and Dr. Gerber’s commentary are nothing to sneeze at whether or not your office offers telehealth services to your patients. Be in the nose, or in the know, and link to this study and commentary to better understand the risks and not just the benefits of using DTC telemedicine for a child with an acute respiratory infection.
