Children seen during telemedicine visits are more likely to be prescribed antibiotics than children seen during in-person doctor or urgent care clinic visits, according to a recent study by UPMC Children's Hospital of Pittsburgh.
Using 2015-2016 claims data from a large national commercial health plan, the researchers examined nearly 530,000 acute respiratory infection medical visits by children aged 0-17 via telemedicine, urgent care and in-person primary care visits. The analysis showed that children received antibiotic prescriptions during 52% of telemedicine visits compared with 42% of urgent care and 31% of primary care visits.
Kristin Ray is the lead author of the study. She says that, as the use of telemedicine outside the pediatric medical home continues to grow, the pediatric medical community must remain focused on quality of care.
“I’m a pediatrician and a parent,” says Kristin Ray, M.D., M.S., pediatrician, Division of General Academic Pediatrics, UPMC Children’s Hospital of Pittsburgh and lead author of the study. “I completely understand the appeal of being able to access care immediately when a child is sick. I appreciate that need and desire for care in the home at all hours. I think we just need to continue, as healthcare systems and individual providers, to make sure we are meeting the demand and need while maintaining the quality that our patients deserve.”
Less compliant with clinical guidelines
Ray and her team of researchers also found that clinical guidelines for antibiotic prescriptions—which are in place to prevent inappropriate use of the drugs to avoid antibiotic resistance or side effects—were less likely to be followed during telemedicine visits than the other types of visits: 59% of telemedicine visits followed clinical guidelines for antibiotic prescribing, versus 67% at urgent care and 78% at primary care visits.
Similar research in adult population proves kids need special care
“We did a similar study in the adult population and found that there wasn’t a noticeable difference between the care that adults were getting in primary care versus urgent care versus telemedicine,” says Ray. “The fact that there was such a large difference for kids underscores the point that children aren’t just little adults. They need child-specific care and child-specific healthcare delivery systems.”
Ray points out that the in-person exam may be much more important for children—especially pre-verbal children—because they can’t describe their symptoms like adults can. This could lead to prescribing antibiotics.
“This is a possible theory that we can’t test or prove with this data,” says Ray.
A myriad of models
There is a wide range of telemedicine models—some have additional peripherals where clinicians can enable testing; others have individual doctors caring for their own patients through telemedicine. And now, some telemedicine companies are trying to work testing into their own models, Ray says, to be able to send patients for things like strep throat swabs.
“Telemedicine is not black and white,” says Ray. “As it continues to grow, we need to think about the ways it should grow to facilitate high-quality care. We also need to make sure we build up policies and protocols to support those sorts of programs.”
Ray says that telemedicine ventures should implement the same antibiotic stewardship processes in place within hospitals or clinics. Also, there should be appropriate partnerships and informational continuity around diagnoses that would facilitate transitioning of patients to an in-person visit when the care cannot be completed adequately in a telemedicine encounter.
Thinking about offering telemedicine?
Whether you are forming a partnership with a company or starting your own telemedicine service within your children’s hospital, here’s Ray’s advice: “Think about the quality metrics that the venture should target and make sure that information is available to key decision-makers to ensure that the appropriate quality is provided. And if not, be sure that internal protocols are addressing that. Ongoing attention to quality is part of any initiative that is striving to improve access to care.”