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Pediatric telemedicine visits may increase antibiotic overprescribing

Telemedicine use for acute issues among children have increased, but along with that is an apparent increase in antibiotic overprescribing.

Jeff Lagasse, Associate Editor

Telemedicine is exploding at the moment, with scores of providers beginning to offer the online, remote-care service as a means of bettering health. It also supports healthy revenue cycles by opening up a new income stream.

But a new study suggests a little caution might be in order.

Children with acute respiratory infections were prescribed antibiotics more often during direct-to-consumer telemedicine visits than during in-person primary care appointments or urgent care visits, according to UPMC Children's Hospital of Pittsburgh research reported in Pediatrics.

Telemedicine use for acute, primary care issues among children have increased in recent years, but along with that is an apparent increase in antibiotic overprescribing.


The researchers examined 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.

The team compared antibiotic prescribing for acute respiratory infections among pediatric direct-to-consumer telemedicine visits compared to visits at primary care offices and urgent care centers which were matched by age, state, diagnosis and other variables.

Among the core findings were that children received antibiotic prescriptions during 52 percent of telemedicine visits, compared with 42 percent of urgent care and 31 percent of primary care provider visits.

Compared to primary care and urgent care visits, the antibiotics received at telemedicine visits also were less likely to be consistent with clinical guidelines. The use of antibiotics that are not necessary or that are broader than necessary may result in side effects and contribute to antibiotic resistance.

These differences in antibiotic prescribing were much larger than differences found in similar analyses of direct-to-consumer telemedicine visits by adults. That, the authors said, underscores the need for pediatric-specific analyses of health system innovations.


Despite the need for caution, telemedicine has been a transformative offering. The model has shown promise in creating new reimbursement streams for providers, as well as in improving the health of rural residents especially.

For cardiovascular patients in particular, it may improve their satisfaction with their postoperative care as well as their quality of life.

Twitter: @JELagasse

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