Telemedicine linked to more antibiotics for children, reveals a study

NEW YORK

According to a new study, children with sore throat and sore throats during telemedicine visits were much more likely to be prescribed antibiotics than those who went to the doctor or clinic.

Many of these prescriptions have violated medical guidelines, increasing the risk of adverse effects or contributing to the proliferation of antibiotic-resistant germs.

"I understand the desire for care that is more convenient and timely," said Kristin Ray, senior author of the study, from the University of Pittsburgh. "But we want to make sure not to sacrifice quality, safety, or efficiency in the process."

The study was published Monday in the journal Pediatrics.

Ray and his colleagues examined more than 340,000 insured children who had acute respiratory medical visits in 2015 and 2016.

Children received prescriptions for antibiotics more than half of the time during telemedicine visits, compared to 42% in emergency clinics and 31% in doctors' offices.

While over-prescribing can help germs develop antibiotic resistance and turn into impossible-to-treat superbugs, they can also result in unnecessary costs for medical bills and even cause serious side effects, said expert Tim Landers. Antibiotic resistant infections from Ohio State University.

"These are not harmless drugs," said Landers, who did not participate in the study.

The researchers also found that by examining physicians' decisions in telemedicine on the advisability of prescribing antibiotics or not, 4 out of 10 did not comply with medical guidelines to match treatment with diagnosis. This mainly involved physicians who prescribed drugs that fought against bacteria to treat viral diseases, such as colds and flu, unaffected by antibiotics.

In comparison, 3 decisions on 10 out of 10 emergency care centers were inappropriate, and about 2 decisions on a doctor 's office out of 10 were.

The researchers also found that telemedicine physicians seemed to ignore other guidelines. For example, doctors are supposed to do a throat swab and do a lab test before diagnosing strep throat. But that's rarely happened during telemedicine visits, Ray said.

A large recent study of antibiotic prescribing habits in adults has revealed little difference between telemedicine and office visits. But there have been few studies on the issue in children.

During telemedicine visits, patients interact with doctors and nurses through video or audio calls. They can be less expensive and easier than trying to enter the office of a pediatrician or transporting children to an emergency care center.

Some physicians and hospital systems use technology for consultations, but the study focused on consumer telemedicine programs that a person can access without having to talk to their doctor. Only about 1% of the sick children participating in the study were seen during these visits.

The American Academy of Pediatrics, which publishes the newspaper, encourages parents not to use such consumer programs. Academy officials say limited physical exams and lack of access to patient records can hinder care.

But telemedicine seems to be gaining ground, particularly among employers who think they can save money, said Jason Doctor, a researcher in health policy and economics at the University of Southern California.

Doctor is studying ways to improve the prescription of antibiotics in telehealth companies. This is a big problem, he said, because "telemedicine is going to get bigger and it will become a more common part of people's medical care."