Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits
Open accessAbstract
BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS: In a retrospective cohort study using 2015–2016 claims data from a large national commercial health plan, we identified ARI visits by children (0–17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.
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Higher antibiotic prescribing was found in children seen via telemedicine than in person.
“Ray et al. [30] who found higher antibiotic prescribing in children seen via telemedicine than in person.”
From Patient safety risk associated with synchronous telehealth: A scoping review (2025) · cites this paper as [30]
Ray et al 2019 reported that for acute respiratory infection, the antibiotic-prescribing rate was 52% in remote consultations versus 31% in face-to-face consultations (P<.001).
“Intervention: 52%, control: 31% (P<.001)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [27]
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 [27]
The review found 4 observational studies that reported guideline-concordant or guideline-recommended prescribing rates, measuring appropriateness against local or national guidelines.
“We found 4 observational studies that reported guideline-concordant prescribing rates or guideline-recommended prescribing rates, which measured the appropriateness of the prescriptions against local or national guidelines [22,25-27] (Table 2).”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [27]
Conflicting results were observed for guideline-concordant prescribing for patients with acute respiratory infection.
“However, conflicting results were observed for patients with acute respiratory infection [25,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [27]
In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations.
“In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations [22,24,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [27]
All 4 guideline-concordant prescribing studies were from the United States and investigated populations with confirmed sinusitis, UTI, or acute respiratory infection.
“All studies were from the United States and investigated populations with a confirmed diagnosis of sinusitis [22,26], UTI [22], or acute respiratory infection [25,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [27]
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References 46 · Cited by 206
Research works printed but not linked: 2
- National Business Group on Health. NBGH press release: large U.S. employers project health care benefit costs to surpass $14,000 per employee in 2018, National Business Group on Health survey finds. 2017. Available at: https://www.businessgrouphealth.org/ news/nbgh-news/press-releases/press- release-details/?ID=334. Accessed February 28, 2019.
- Gali K, Faiman M, Romm S. Ensuring clinical quality in telemedicine. NEJM Catalyst. 2018. Available at: https:// catalyst.nejm.org/clinical-quality- telemedicine-online-care/. Accessed October 12, 2018
- Authors
- Ray, K. N., Shi, Z., Gidengil, C. A., Poon, S. J., Uscher-Pines, L., & Mehrotra, A.
- Affiliations
- University of Pittsburgh (US)
- Harvard University (US)
- Boston Children's Hospital (US)
- Brigham and Women's Hospital (US)
- RAND Corporation, Arlington, Virginia; and
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- Ray, Kristin N.
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2019-05-01
- Volume
- 143
- Issue
- 5
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC6565339
- OpenAlex
- W2937757335
- Cited by
- 206
- References
- 46
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 19 · 2023: 20 · 2022: 43 · 2021: 50 · 2020: 35 · 2019: 13 · 2014: 1
- FWCI
- 22.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD088642)
- Topics
- 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
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- antibiotic prescribing, direct-to-consumer telemedicine, pediatric respiratory infection, guideline-concordant care, urgent care visits, primary care visits, children, antibiotic overuse, telemedicine
- MeSH terms
- Direct-to-Consumer Advertising, Adolescent, Ambulatory Care, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Pediatrics, Drug Prescriptions, Retrospective Studies, Cohort Studies, Telemedicine
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