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Direct-to-consumer telemedicine visits may lead to pediatric antibiotic overprescribing

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DTC telemedicine: “A vehicle for antibiotic overuse”

These findings from this study illustrate the issues with direct-to-consumer (DTC) telemedicine, especially when treating children, according to Jeffrey S. Gerber, MD, medical director of the antimicrobial stewardship program at Children’s Hospital of Philadelphia.

The best way to get a 5-star rating after a DTC telemedicine visit is to prescribe an antibiotic, Dr. Gerber wrote, so it shouldn’t be surprising that doctors are handing them out at a higher rate than after an urgent care or a primary care visit. It should also be noted that this study covers a very specific privately insured population and that DTC telemedicine remains a “small piece of the pie,” for now, in terms of patient care.

But, he added, the most problematic element of this study may be that none of the 3 most common pediatric acute respiratory tract infection (ARTI) diagnoses should be followed with an immediate prescription, especially after a virtual visit.

“It could be argued that essentially no ARTI encounters should lead to antibiotic prescriptions solely on the basis of a DTC telemedicine visit,” he wrote, recognizing that – though there may be value for telemedicine in a screening capacity – the DTC version seems to be a “low quality encounter” at best and “a vehicle for antibiotic overuse” at worst.

These comments are adapted from an accompanying editorial (Pediatrics. 2019 Apr 8. doi: 10.1542/peds.2019-0631 ). Dr. Gerber reported receiving personal fees from Medtronic outside the submitted work.



Children who are treated via direct-to-consumer (DTC) telemedicine are more likely to be prescribed antibiotics for acute respiratory infections (ARIs), according to a study of antibiotic prescriptions for ARIs across 3 clinical settings.

“These differences in antibiotic prescribing for children contrast with previous studies of DTC telemedicine quality among adult patients in which quality differences have been smaller or nonexistent,” wrote Kristin N. Ray, MD, of Children’s Hospital of Pittsburgh, and her coauthors. The study was published in Pediatrics.

To determine quality of care during pediatric DTC telemedicine visits, the researchers embarked on a retrospective cohort study using 2015–2016 claims data from a large national commercial health plan. They identified visits for ARIs and matched them across 3 settings: DTC telemedicine, urgent care, and PCP offices. The matched sample included 4,604 DTC telemedicine visits, 38,408 urgent care visits, and 485,201 PCP visits.

Their analysis showed that children were more likely to be prescribed antibiotics at DTC telemedicine visits than in other settings (52% versus 42% for urgent care and 31% for PCP, P less than .001). In addition, they were less likely to receive guideline-concordant antibiotic management (59% versus 67% and 78%, P less than .001). This was primarily attributed to “antibiotic prescribing for visits with viral ARI diagnoses that do not warrant antibiotics,” antibiotics were appropriately not prescribed in only 54% of those DTC telemedicine visits, compared with 66% for urgent care and 80% for PCP (P less than .001).

The authors shared the limitations of their study, including a lack of sociodemographic or clinical data stemming from a reliance on insurance claims. They also noted that their analysis was limited to a specific health plan and its contracted DTC telemedicine vendor, recognizing that “antibiotic prescribing among other DTC telemedicine companies, models, and populations may differ.”

The study was funded by the National Institutes of Health and supported in part by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and gifts from Melvin Hall. The authors reported no conflicts of interest.

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