Evidence suggests that patients are increasingly using telemedicine for non-urgent ailments, including pediatrics respiratory tract infections (RTIs). “Antibiotic overuse is a problem in all care settings, but my colleagues and I wanted to better understand the challenges associated with diagnosing and treating RTIs in pediatric telemedicine encounters,” explains Charles B. Foster, MD.
For a study published in Pediatrics, Dr. Foster and colleagues analyzed data from a nationwide direct-to-consumer (DTC) telemedicine platform focusing on antibiotic prescribing practices for pediatric RTIs. “We were interested in determining whether the parent’s satisfaction with the telemedicine provider correlated with the visit length or whether an antibiotic was prescribed,” says Dr. Foster. The researchers found that pediatric patients were prescribed antibiotics in more than 50% of tele-visits. “Receipt of an antibiotic was the strongest single predictor of satisfaction, and the physician’s prescribing rate correlated with their overall satisfaction ratings,” Dr. Foster notes. Pediatricians, however, had a lower antibiotic prescribing rate than other physicians and overall higher satisfaction rates. Dr. Foster feels this may be because pediatricians spent more time with patients. When antibiotics were prescribed there was no correlation between visit length and patient satisfaction. However, when no antibiotic was prescribed, satisfaction correlated with visit length, overall and for pediatricians alone.
The study showed high satisfaction rates among parents using DTC telemedicine for their child’s RTI. Telemedicine is convenient and is becoming an important alternative to traditional care. However, Dr. Foster warns that “regardless of the practice venue, it’s important for providers to strive to provide guideline-concordant care and to use antibiotics judiciously. In telemedicine, for example, this might mean that a child with suspected group A streptococcal pharyngitis needs referral to a laboratory or a clinic before antibiotics are started. You can’t make that diagnosis without a throat culture.”
Dr. Foster adds that hospitals and companies providing telemedicine services have an obligation to assess their own data to drive quality improvement initiatives. “Telemedicine providers who do this should be commended; the best healthcare organizations are passionate about continuous improvement,” he says. “The platform is relatively new, so how to best do this is not clear. Perhaps, there are innovative technologies that can be used to improve the physical exam or partnerships that can facilitate diagnostic testing or in person evaluations.”