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Study Compares Differences in Antibiotic Prescribing for Pediatric Acute Respiratory Tract Infection Between Primary Care Telemedicine, Virtual-Only DTC Telemedicine Appointments


Investigation aimed to discern whether the differences in antibiotic prescribing between direct-to-consumer telemedicine appointments and primary care physician telemedicine appointments were due to the care modality or the context of the care.

Medication showcase: Tablets falling on a dark backdrop. Generative AI. Image Credit: Adobe Stock Images/Muhammad Shoaib

Image Credit: Adobe Stock Images/Muhammad Shoaib

Since the beginning of the COVID-19 pandemic, direct-to-consumer (DTC) telemedicine has become much more common. During the first year and a half of the pandemic, most pediatric telehealth appointments for pediatric acute respiratory tract infections (ARTIs) involved primary care physicians (PCPs), with most antibiotics still being prescribed in person. As time went on, this became more common with DTC appointments. As a result, a recent JAMA Network study aimed to discover how telemedicine visits with primary care practitioners for ARTIs affect antibiotic use compared with DTC organizations.

For the study, researchers analyzed 27,686 pediatric telemedicine visits for ARTIs from a national sample of commercially insured children from 2022. Initial results found that telemedicine visits with PCPs resulted in lower antibiotic prescription rates (28.9%) than DTC vendors (37.2%).

Other findings included:

  • PCP visits were less likely to justify the use of antibiotics or provide a follow-up appointment within the next two weeks.
  • No major differences were found regarding guideline-concordant antibiotic management between PCP and DTC visits, opening up the possibility that antibiotic qualities were similar between the two.
  • Higher rates of prescribing antibiotics in the DTC space could be related to incentives for healthcare professionals, inabilities to schedule follow-ups, and possibly the use of nonpediatricians.1

“While prior research has reported increased antibiotic use in pediatric DTC telemedicine visits, it has been unclear whether the higher rate of antibiotic receipt observed with DTC telemedicine visits was associated more with the modality of care (telemedicine vs in-person) or context of telemedicine care (eg, telemedicine used in virtual-only, nonprimary care contexts),” explained the study authors. “Our findings support that the difference is largely associated with the context of telemedicine use (rather than telemedicine itself) given the lower rates of antibiotic receipt for PCP telemedicine visits.”

Despite the growth of DTC health services, only a small number of older Americans have used the service, according to a recent national poll by the University of Michigan. Additionally, only one-third of those who have used the service went on to inform their regular health care providers (HCPs) when given a prescription. As a result of these communication issues, concerns have arisen regarding risks to patient care and care continuity.2,3

"These compelling findings have important implications for patient safety and continuity of care," said Mark Fendrick, MD, director, VBID, IHPI member, said in a press release. "With rapid growth in this sector of health care predicted for this year and beyond, all providers, insurers and regulators need to pay more attention to how patients are using these services and why, and the impact on care quality and safety."

Authors of the JAMA study stated that the difference in care modality is largely associated with the context of telemedicine use, mainly due to the lower rates of antibiotic receipt for PCP telemedicine visits. Despite results showing that DTC telehealth visits ended with more antibiotic prescriptions, they found that there were similar methods of managing antibiotic guidelines.1

“It is possible that there was a true difference in the case mix of ARTI conditions that presented to each site (perhaps due to differential parent site selection or practice site triage protocols),” said the study authors. “Alternatively, prior studies indicate that urgent care clinicians with higher rates of antibiotic prescribing are more likely to provide diagnoses for which antibiotics may be indicated and to prescribe antibiotics, highlighting potential subjectivity in diagnoses.”

While the study provided some answers, the authors acknowledged that more research needs to be done. Specifically, the study was an observational analysis of claims data, resulting in less clinical data. Going forward, they suggest future research efforts should feature alternative data while focusing on additional patient and practitioner characteristics associated with the same outcomes.1

“The results of this cross-sectional study suggest that compared with DTC telemedicine platforms, telemedicine integrated within primary care may perform better in terms of less antibiotic use and reduction of subsequent health care visits. Based on these results, it appears that evolving telemedicine policy may need to account for different models and quality of telemedicine care and should support ongoing integration of telemedicine within pediatric primary care,” the authors concluded.


1. Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors. The JAMA Network. March 14, 2024. Accessed March 15, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816194

2. Poll Reveals Only a Small Number of Older Americans Have Used Online Direct-to-Consumer Health Services. Pharmaceutical Executive. January 17, 2024. Accessed March 15, 2024. https://www.pharmexec.com/view/poll-reveals-only-a-small-number-of-older-americans-have-used-online-direct-to-consumer-health-services

3. Few older adults use direct-to-consumer health services; Many who do don't tell their regular provider. Science Daily. January 14, 2024. Accessed March 15, 2024. https://www.sciencedaily.com/releases/2024/01/240114113649.htm

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