Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage
Abstract
Objective: The objective of this research paper is to compare antibiotic treatment, follow-up rates, and types of follow-up encounters among eVisits, phone calls, and in-person encounters for pediatric conjunctivitis. Study design: A retrospective chart review of pediatric patients evaluated for conjunctivitis between May 1, 2016 and May 1, 2017, was performed. A total of 101 eVisits, 202 in-person retail clinic visits, and 202 nurse phone calls for conjunctivitis were manually reviewed for outcomes. Exclusion criteria included previous encounter for conjunctivitis in the past 14 days, treatment with an oral antibiotic at the initial encounter, or patient outside Minnesota at the time of encounter. Comparison among the three encounter types with regard to follow-up rates, follow-up encounter type within 14 days of initial evaluation, and prescribing rates was performed. Results: Patients completing non-face-to-face encounters were significantly more likely to have follow-up care (34.6% and 45.5%) than those who had a face-to-face visit at the retail clinic (7.4%), p ≤ 0.0001. Patients initially evaluated by eVisit were more likely to have follow-up at the retail clinic while patients initially evaluated by phone call were more likely to have follow-up in their primary care office. Treatment rates with antibiotics were significantly higher in phone call encounters (41.6%) than in eVisits (25.7%) or face-to-face encounters (19.8%), p < 0.0001. Conclusions: Non-face-to-face visits have significantly higher rates of follow-up when compared to face-to-face encounters. Antibiotic prescribing is greater with phone call triage encounters; however, there was no significant difference in antibiotic prescribing rates between eVisits and face-to-face visits. Follow-up type varied according to site of initial encounter.
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We found 3 studies that reported the antibiotic-prescribing rate to be higher in remote settings than face-to-face consultations.
“We found 3 studies that reported the antibiotic-prescribing rate to be higher in remote settings than face-to-face consultations [19,22,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
Penza et al found higher antibiotic-prescribing rates for both telephone and text-based e-visits, but only the difference in telephone consultations was statistically significant.
“Penza et al found this relationship for both telephone and text-based e-visits, but only the difference in telephone consultations was statistically significant [19].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
Penza et al 2020 reported that for conjunctivitis, the antibiotic-prescribing rate during telephone consultations was 41.6% in remote consultations versus 19.8% in face-to-face consultations (P<.0001).
“Intervention: 41.6%, control: 19.8% (P<.0001)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
Penza et al 2020 reported that for conjunctivitis, the antibiotic-prescribing rate from text-based e-visits was 25.7% in remote consultations versus 19.8% in face-to-face consultations (P=.24).
“Intervention: 25.7%, control: 19.8% (P=.24)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
Penza et al found higher follow-up rates in both e-visits and telephone consultations than in face-to-face consultations 7 days after the initial visit.
“Results from the Penza et al [19] study indicated higher follow-up rates in both e-visits and telephone consultations than in face-to-face consultations 7 days after the initial visit.”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
Of these 5 studies, 3 found that patients seen remotely were more likely to have another follow-up visit than those who attended face-to-face consultations.
“Of these 5 studies, 3 found that patients who were seen remotely were more likely to have another follow-up visit than those who attended face-to-face consultations [19,25,26].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
The review found 5 US-based retrospective cohort studies that investigated follow-up visit rates after initial consultation for the same presentation.
“We found 5 US-based retrospective cohort studies that investigated follow-up visit rates after initial consultation for the same presentation [18,19,22,25,26].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [19]
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- Authors
- Penza, K. S., Murray, M. A., Myers, J. F., Maxson, J., Furst, J. W., & Pecina, J. L.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Pecina, Jennifer L
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2018-08-28
- Volume
- 26
- Issue
- 1-2
- Pages
- 73-78
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W2888925251
- Cited by
- 27
- References
- 23
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 5 · 2020: 5 · 2019: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Clinic Department of Family Medicine
- Topics
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- pediatric conjunctivitis, telephone triage, retail clinics, follow-up care, antibiotic prescribing, telemedicine
- MeSH terms
- Aftercare, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Conjunctivitis, Female, Humans, Male, Primary Health Care, Retrospective Studies, Telephone, User-Computer Interface, Telemedicine, Mobile Applications
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