News: Telemedicine visits linked to fewer prescribed antibiotics for pediatric respiratory infections

Children seen by primary care physicians for acute respiratory tract infections were prescribed antibiotics less often during telemedicine appointments, without a rebound in prescribing or visits afterward, a recent study published in JAMA Network Open found.

Across the nearly 700 primary care practices included in the retrospective cross-sectional study, antibiotics were prescribed in 34.6% of telemedicine visits compared with 46.8% of in-person visits. There were no significant differences in antibiotic management guideline concordance between the two groups, or in follow-up visits and antibiotic prescription within 14 days after the initial visit.

The study included 438,148 in-person visits and 11,482 telemedicine visits for acute respiratory tract infections in 2023 among 302,817 children at 694 primary care practices participating in the Telemedicine Integrated into Pediatric Primary Care dataset. The practices included community health organizations, independent pediatric practices, and practice networks affiliated with large health systems.

Researchers were unable to distinguish between audio-only and audio-video telemedicine visits, which posed a limitation to the study. Additionally, the use of telemedicine was relatively low, with just 2% of all acute respiratory tract infection-related visits.

“Supporting primary care practices in providing telemedicine for acute care, such as for [acute respiratory tract infections], may be a way to promote antibiotic stewardship while providing ease of access for families,” reported Kristin N. Ray, MD, of the University of Pittsburgh School of Medicine, and colleagues.

The difference in prescribing in this study appeared to be caused by more frequent telemedicine diagnoses of viral infections and sinusitis, by 11.3% and 9.9% respectively. On the other hand, in-person encounters led to more acute otitis media and streptococcal pharyngitis diagnoses, by 15.3% and 5.9% respectively.

Telemedicine doesn’t allow visualize of the tympanic membrane to diagnose acute otitis media or rapid diagnostic testing for streptococcal pharyngitis, which are “both known to be overdiagnosed and overtreated in in-person settings,” wrote Matthew P. Kronman, MD, of Seattle Children's Research Institute, and Rana F. Hamdy, MD, MPH, of Children's National Hospital in Washington, D.C. in an accompanying editorial.

While the study "raises important questions about clinical decision-making in the absence of certain examination components," it also "underscores the idea that telemedicine visits can represent a crucial tool for treating children with acute respiratory infections," they added.

Editor’s note: To read the full study, click here. To read additional coverage by MedPage Today, click here.