Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits.

Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE

Publication: Elk Grove Village Il : American Academy of Pediatrics
Original Publication: Springfield, Ill., Thomas.

Drug Prescriptions*/standards; Ambulatory Care/*trends ; Anti-Bacterial Agents/*therapeutic use ; Direct-to-Consumer Advertising/*trends ; Pediatrics/*trends ; Telemedicine/*trends; Adolescent ; Ambulatory Care/standards ; Ambulatory Care Facilities/standards ; Ambulatory Care Facilities/trends ; Child ; Child, Preschool ; Cohort Studies ; Direct-to-Consumer Advertising/standards ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Retrospective Studies ; Telemedicine/standards

Background and Objectives: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office.
Methods: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.
Results: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons).
Conclusions: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.
Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
(Copyright © 2019 by the American Academy of Pediatrics.)

Comment in: Pediatrics. 2019 May;143(5):. (PMID: 30962254)
Comment in: Pediatrics. 2019 Aug;144(2):. (PMID: 31366682)
Comment in: Pediatrics. 2019 Aug;144(2):. (PMID: 31366684)
Comment in: Pediatrics. 2019 Aug;144(2):. (PMID: 31371527)
Comment in: Evid Based Nurs. 2021 Apr;24(2):36. (PMID: 32312739)

Hosp Pediatr. 2017 Jul;7(7):373-377. (PMID: 28634166)
JAMA. 2016 Feb 9;315(6):562-70. (PMID: 26864410)
JAMA Intern Med. 2018 Oct 1;178(10):1342-1349. (PMID: 30193357)
JAMA. 2016 May 3;315(17):1864-73. (PMID: 27139059)
Am J Manag Care. 2015 Apr;21(4):294-302. (PMID: 26014468)
BMC Health Serv Res. 2009 May 15;9:79. (PMID: 19445656)
BMJ. 2003 Nov 22;327(7425):1219-21. (PMID: 14630762)
Ann Intern Med. 2003 Apr 1;138(7):525-33. (PMID: 12667022)
Pediatrics. 2006 Mar;117(3):595-602. (PMID: 16510636)
J Pediatric Infect Dis Soc. 2015 Dec;4(4):297-304. (PMID: 26582868)
Telemed J E Health. 2016 Apr;22(4):282-7. (PMID: 26488151)
Pediatr Ann. 2014 Feb;43(2):e33-8. (PMID: 24512159)
Telemed J E Health. 2010 Jun;16(5):533-42. (PMID: 20575720)
Pediatrics. 2011 Dec;128(6):1053-61. (PMID: 22065263)
Acad Pediatr. 2019 Aug;19(6):665-669. (PMID: 30639759)
Clin Infect Dis. 2012 Nov 15;55(10):1279-82. (PMID: 23091044)
Health Aff (Millwood). 2017 Mar 1;36(3):485-491. (PMID: 28264950)
JAMA. 2013 Jun 12;309(22):2345-52. (PMID: 23757082)
JAMA. 2017 Oct 10;318(14):1391-1392. (PMID: 29049577)
Inquiry. 2016 Apr 20;53:. (PMID: 27098876)
JAMA Intern Med. 2015 Jul;175(7):1234-5. (PMID: 26011763)
Pediatrics. 2013 Mar;131(3):e964-99. (PMID: 23439909)
JAMA Intern Med. 2018 Sep 1;178(9):1267-1269. (PMID: 30014128)
JAMA Intern Med. 2013 Jan 14;173(1):72-4. (PMID: 23403816)
Pediatrics. 2014 Nov;134(5):e1474-502. (PMID: 25349312)
Pediatrics. 2013 Jul;132(1):e262-80. (PMID: 23796742)
Pediatrics. 2017 May;139(5):. (PMID: 28557775)
Telemed J E Health. 2013 Jul;19(7):515-9. (PMID: 23682589)
Br J Gen Pract. 2016 Mar;66(644):e207-13. (PMID: 26852795)
Health Aff (Millwood). 2018 Dec;37(12):2014-2023. (PMID: 30633682)
JAMA. 2009 Aug 19;302(7):758-66. (PMID: 19690308)
J Gen Intern Med. 2016 Aug;31(8):918-24. (PMID: 27067351)
Pediatrics. 2013 Apr;131(4):677-84. (PMID: 23509168)
Cochrane Database Syst Rev. 2017 Sep 07;9:CD012252. (PMID: 28881002)
JAMA Pediatr. 2014 Nov;168(11):1073-4. (PMID: 25264869)
MMWR Recomm Rep. 2016 Nov 11;65(6):1-12. (PMID: 27832047)
Telemed J E Health. 2017 Sep;23(9):699-706. (PMID: 28829680)
Pediatrics. 2018 Jun;141(6):. (PMID: 29793986)

K23 HD088642 United States HD NICHD NIH HHS

0 (Anti-Bacterial Agents)

Date Created: 20190410 Date Completed: 20191115 Latest Revision: 20231104

20231215

PMC6565339

10.1542/peds.2018-2491

30962253