Is Telemedicine The Best Choice for KIds?

By Jane Farrell

Doctors who have “telemedicine” visits with pediatric patients prescribe antibiotics more often than do urgent-care clinics or regular office visits, according to new research.

Many health insurance companies offer coverage for “direct-to-consumer” telemedicine visits, in which people use their personal devices to connect with doctors. These types of visits are becoming more common for both adults and children.

But experts caution against using telemedicine for children, particularly for acute problems like respiratory tract infections. Such infections include colds, sore throats, and ear infections. Kids may not be able to describe their symptoms. Specific physical exams or tests might also be needed that aren’t possible during telemedicine visits. For example, diagnosing an ear infection requires the doctor to look inside the ear canal. Diagnosing strep throat requires a strep test.

A team of researchers led by Dr. Kristin Ray at the University of Pittsburgh compared the quality of care delivered to children via telemedicine with that at urgent care facilities and during primary care visits. The team used 2015–2016 claims data from a large national health plan to assess how frequently doctors prescribed antibiotics to children for respiratory infections. Some of these diagnoses may benefit from antibiotics, while others do not.

Experts caution against the overuse of antibiotics, particularly for problems such as acute respiratory infections.

More than 5,000 children with respiratory infections received care via telemedicine, about 88,000 at urgent care, and more than 1 million by primary care doctors. The team tallied the antibiotics dispensed within two days for each type of visit.

Among visits matched by patient and visit characteristics, the team found that doctors prescribed antibiotics for respiratory infections at 52% of telemedicine visits, 42% of urgent care visits, and 31% of primary care visits.

Next, the team analyzed whether antibiotics were prescribed according to clinical guidelines for the diagnoses received. These guidelines help prevent inappropriate use of antibiotics, such as for treating viral infections. Antibiotics can save lives, but any time these drugs are used, they can cause side effects and lead to antibiotic resistance. Only 59% of telemedicine visits met the guidelines, compared with 67% of urgent care visits and 78% of primary care visits.

“As a pediatrician and a parent, I understand the appeal of telemedicine when a child is sick, since it offers the promise of connecting with a doctor in a way that is convenient and timely,” Ray said. “But it is important to make sure that the quality of care that children receive remains high.”

This study was the first to compare the quality of care for children at these three settings. The results suggest that primary care and urgent care settings provide higher quality care for respiratory infections than direct-to-consumer telemedicine.

The research was supported by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The results appeared online on April 8, 2019, in Pediatrics.