By An-Li Herring
Within primary care settings, telemedicine may offer as high a level of care as in-person visits for prescribing antibiotics to children with common respiratory infections—a reassuring finding for families that seek to balance the convenience of telehealth with the need for high-quality care.
In a study published May 1 in JAMA Network Open, researchers at the University of Pittsburgh and collaborating institutions compared treatment decisions for children diagnosed with acute respiratory tract infections, such as sinus infections and strep throat, as well as ear infections and viral upper respiratory infections. Using data from 694 pediatric and family medicine primary care practices across the United States, the study compared antibiotic prescribing patterns between office visits and telemedicine appointments.
The study found that antibiotic prescribing during primary care virtual visits met quality standards at rates similar to those seen during in-person office visits. While physicians prescribed antibiotics less often during telemedicine visits than during in-person appointments, clinicians in both settings were similarly likely to follow prescribing guidelines that aligned with visit diagnosis. Children who received primary care virtual visits were no more likely than children seen in person to need follow-up visits or subsequent antibiotic prescriptions, suggesting that children who met virtually with primary care physicians generally received the same quality of antibiotic prescribing as children seen in person. Because telemedicine clinicians can instruct patients to obtain in-person care instead, their ability to switch the modality of care when appropriate may enhance the quality of antibiotic prescribing in primary care.
“[The study] shows that primary care docs are being good stewards of telehealth and antibiotics, and balancing those well together,” said lead author Kristin Ray, associate professor of pediatrics (Division of General Academic Pediatrics), School of Medicine, at the University of Pittsburgh.
Because unnecessary antibiotic use contributes to growing antimicrobial resistance, researchers seek ways to avoid overprescribing. Physicians have long questioned whether telemedicine might encourage more “just in case” prescribing, particularly when clinicians are uncertain whether an infection is bacterial or viral. Antibiotics fight bacteria but do not work against viruses, so some clinicians have worried that the lack of a hands-on physical exam during virtual visits could make bacterial infections harder to rule out and sometimes lead practitioners to prescribe antibiotics unnecessarily.
In earlier research, Ray and colleagues found that commercial direct-to-consumer telehealth providers prescribed antibiotics more often and followed prescribing guidelines less consistently than clinicians who saw patients in person in primary care or urgent care settings.
“We had a suspicion that telehealth itself wasn't completely the reason for this,” Ray said. “It was about maybe the context, maybe the pressures, the incentives, the [lack] of continuity and relationship-building that was able to happen during these virtual urgent care visits.”
Researchers have suspected that, in addition to having limited familiarity with patients, commercial telemedicine providers face more pressure to satisfy antibiotic demand in brief encounters with fewer opportunities for follow-up care.
Ray is a practicing pediatrician at UPMC Children's Hospital of Pittsburgh, where she sees patients both virtually and in person. She noted that telehealth is better suited to some conditions than others. Diagnosing ear infections requires physicians to examine the ear directly, and strep throat generally requires a swab test. Sinus infections, by contrast, can often be evaluated based on symptoms and medical history, making them more practical to assess virtually.
Virtual care can also ease burdens on families by limiting travel and allowing children to remain in familiar, more comfortable environments during appointments, Ray noted. In some cases, she added, seeing children at home may even help physicians better assess the child’s symptoms and behavior.
Ray said the results raise broader questions about how health systems and insurers can support high-quality telehealth within primary care practices, including reimbursement policies that allow clinicians to continue offering virtual care alongside in-person visits.