MONDAY, April 8, 2019 (Pharmacist's Briefing) -- For children with acute respiratory infections (ARIs), antibiotic prescribing is higher and guideline-concordant antibiotic management is lower with direct-to-consumer (DTC) telemedicine visits compared with other settings, according to a study published online April 8 in Pediatrics.
Kristin N. Ray, M.D., from the University of Pittsburgh and Children's Hospital of Pittsburgh, and colleagues conducted a retrospective cohort study using 2015 to 2016 claims data from a national commercial health plan for ARI visits by children (aged 0 to 17 years). The percentage of ARI visits with any antibiotic prescribing and percentage of ARI visits with guideline-concordant antibiotic management were compared for ARI visits among children across three settings: DTC telemedicine (4,604 visits), urgent care (38,408 visits), and primary care provider (PCP) office (485,201 visits).
The researchers found that compared with other settings, antibiotic prescribing was higher in DTC telemedicine (52 versus 42 and 31 percent for DTC telemedicine versus urgent care and PCP visits, respectively). Compared with other settings, there was also lower guideline-concordant antibiotic management during DTC telemedicine visits (59 versus 67 and 78 percent, respectively).
"For pediatric acute respiratory tract infections, the DTC version seems to be at best a low-quality encounter and at worst a vehicle for antibiotic overuse," write the authors of an accompanying editorial.