Telemedicine Possibly Tied to Increased Antibiotic Prescriptions

The important role that antibiotics have come to play in
modern health care is undeniable. But as instances of antibiotic-resistant
infection continue to arise, it has become abundantly clear that antibiotic
overuse can present danger to patients—and as one new study highlights, the use
of telemedicine could be making the problem a bit worse among pediatric
patients. As the Associated Press first reported, a recent study published in
the journal Pediatrics found that children who had telemedicine visits were
much more likely than those who had in-person visits to receive an antibiotic
prescription, raising concerns among the authors about overprescribing. “I
understand the desire for care that’s more convenient and timely,” the study’s
lead author, Dr. Kristin Ray of the University of Pittsburgh, told the AP.
“But we want to make sure that we don’t sacrifice quality or safety or
effectiveness in the process.”

Researchers examined data from 340,000 visits that insured
children had for acute respiratory issues between 2015 and 2016. They found
that children were prescribed antibiotics during more than half of telemedicine
encounters; by contrast, 42% of urgent-care visits and 31% of physician office
visits resulted in antibiotic prescriptions. Ohio State University’s Tim
Landers, who studies antibiotic-resistant infections, was mainly concerned
about the potential for a rise in drug-resistant superbugs. “These are not
harmless drugs,” Landers told the AP, also highlighting the unnecessary costs
that antibiotics can impose on patients. The authors of the Pediatrics study
also found that four out of 10 doctors who wrote prescriptions after
telemedicine encounters failed to meet the requisite medical guidelines for
matching a prescription with a diagnosis; by contrast, only three out of 10
providers in urgent-care clinics and two out of 10 in physician offices failed
to meet the guidelines. For its part, the American Academy of Pediatrics is
warning “parents not to use such direct-to-consumer programs,” cautioning that “limited
physical examinations and lack of access to patient records can harm care.”

This isn’t the first study to raise questions about telehealth and the overprescribing of antibiotics. For example, as we reported this past October, a study published in the journal Annals of Internal Medicine found that, when visiting providers via telemedicine for outpatient respiratory tract infections (RTIs), patients who had telemedicine visits were likelier than those who saw their doctors in person to receive prescriptions for antibiotics. Similarly, in 2015, a RAND Corporation study that compared telemedicine visits to face-to-face encounters for acute respiratory infections found that, although both sets of patients were equally likely to receive a prescription for antibiotics, those who had telemedicine visits were likelier to be prescribed broad-spectrum, or less targeted, antibiotics. “The pattern of treatment offered to patients who saw a physician face-to-face vs. those who spoke with a physician on the telephone was not substantially different,” RAND’s Lori Usher-Pines, the study’s lead author, said in a press release at the time. “However, we found the antibiotics prescribed during telemedicine ‘visits’ raised some specific quality concerns that require further attention.”

Click here to read the AP article on the Pediatrics study of overprescribing and telemedicine.

Click here to read the abstract of the Pediatrics article on overprescribing and telemedicine (full article requires payment).


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Thanks !

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