Telemedicine not ideal for kids with respiratory infections

(Reuters Health) - Children with acute respiratory infections were prescribed antibiotics more often when the doctor “visit” was via telemedicine instead of at a primary care office or an urgent care clinic, a new study shows.

“We found that compared to primary care and urgent care, children with these acute respiratory infections who received care through direct-to-consumer telemedicine were much more likely to receive antibiotics and much less likely to receive antibiotics that were appropriate for the diagnosis they were given,” said the study’s lead author, Dr. Kristin Ray, a pediatrician at Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center.

“Sometimes children with diagnoses that don’t benefit from antibiotics - like the common cold - were still given antibiotics,” Ray said. “Sometimes children with diagnoses that may need antibiotics - diagnoses like ear infections, sinus infections and strep throat - received an antibiotic that isn’t the one the guidelines recommend.”

These days, more insurance plans have started covering telemedicine visits through smartphones or other devices, which connect families with doctors who are not affiliated with the child’s usual health care provider, Ray and colleagues note in Pediatrics.

To assess the impact of telemedicine on children’s care, Ray’s team turned to a large national health plan database that covers more than 4 million children in the U.S. annually and contracts with a direct-to-consumer telemedicine vendor. Using 2015-2016 claims data, the researchers compared antibiotic prescribing for acute respiratory infections during pediatric telemedicine visits and during visits to primary care offices and urgent care centers.

Overall, there were 4,604 telemedicine visits, 38,408 urgent care visits and 485,201 primary care provider visits.

Children received antibiotic prescriptions during 52 percent of telemedicine visits, 42 percent of urgent care visits and 31 percent of primary care provider visits.

Ray and her colleagues noted that antibiotics prescribed during telemedicine visits were less likely to be consistent with clinical guidelines compared those prescribed by primary care doctors and at urgent care centers.

In the case of children, the big difference may be in the ability to physically examine the patient, Ray said. “For children with acute respiratory tract infections, the physical exam helps to distinguish ear infections, strep throat, and sinus infections from viral infections like the common cold,” she added.

“As a parent, I understand the desire for care that is convenient and quick when a child is sick,” Ray said. “But it’s important to make sure children also continue to receive high quality care.”

Although telemedicine may offer more opportunities for patients to find care, it’s not always the best choice, said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“While in general, greater access to healthcare is a good thing, I think this is a clear example of where direct-to-consumer telemedicine led to worse care for (some) of these children,” Wu said. “Unfortunately, while telemedicine seems attractive, the product delivered here is not able to provide equivalent diagnostic accuracy to a visit to a primary care provider, where a physician has the ability to look in a child’s ear.”

The other issue, Wu said, is that there is no accountability when telemedicine doctors are seeing a patient a single time as compared to the child’s regular primary care provider. “So there’s no incentive for them to withhold the antibiotics they believe the parents want,” he added.

That doesn’t mean there’s no place for telemedicine. “There are some areas in which it does fine,” Wu said. “Telemedicine for dermatology can work very well. But this is not that.”

SOURCE: Pediatrics, online April 8, 2019.