Telemedicine and Antibiotic Use: One Click Forward or Two Steps Back?

Abstract

* Abbreviations: DTC — : direct-to-consumer RTI — : respiratory tract infection The use of telehealth services in general, and direct-to-consumer (DTC) telemedicine visits in particular, is growing rapidly.1,2 DTC telemedicine (access to a physician via videoconference for a fee) provides obvious benefits for families, including convenience and, for some, lower out-of-pocket costs. A substantial proportion of DTC telemedicine services for children are for respiratory tract infections (RTIs). We applaud the careful and dispassionate analysis of diagnosis, antibiotic prescribing, and patient satisfaction related to RTI treatment that was published in this month’s Pediatrics by Foster et al.3 This study, along with that of Ray et al4 in a previous issue of Pediatrics , reveals the promise of DTC telemedicine, along with attendant risks of antibiotic overuse in pediatric outpatient settings. By using data on 12 842 completed RTI encounters with 560 physicians from a large, national DTC telemedicine provider, Foster et al3 were able to assess factors associated with antibiotic prescribing as well as parents’ satisfaction with the encounters. Their well-executed study includes a broad cross-section of patients across the country, increasing generalizability. The “headline” is that 55% of the visits resulted in antibiotic prescribing, consistent with other recent research on DTC treatment and more than what is suggested in other studies … Address correspondence to Eli Sprecher, MD, MPP, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02215. E-mail: eli.sprecher{at}childrens.harvard.edu