DTC telehealth results in more antibiotics for pediatric patients

March 20, 2024 - Direct-to-consumer (DTC) telehealth visits resulted in higher rates of antibiotic prescriptions for pediatric patients than telehealth visits conducted by primary care physicians (PCPs), according to a new study by UPMC.

Published in JAMA Open Network, the study aimed to assess antibiotic prescriptions for pediatric acute respiratory tract infections during telehealth visits with PCPs compared with virtual visits conducted by commercial DTC telehealth companies.

High rates of antibiotic prescriptions raise concerns about antibiotic resistance, which occurs when germs develop the ability to defeat the drugs designed to kill them. Antibiotic-resistant infections can be challenging to treat, often requiring second- and third-line treatments that can have harmful side effects. In some cases, these infections have no treatment options.

To compare antibiotic prescription rates for pediatric PCP and DTC telehealth appointments, the researchers examined medical and pharmacy claims for acute respiratory tract infections. They gathered the claims data between January 1, 2022, and December 31, 2022, from the OptumLabs Data Warehouse, a national sample of commercial enrollees.

In total, the researchers analyzed data from 27,686 pediatric patients, matching 14,202 PCP telehealth visits to 14,627 DTC telehealth visits.

They found that pediatric patients were less likely to receive a diagnosis that warranted antibiotics during PCP-conducted telehealth visits, with only 19 percent of visits resulting in such a diagnosis, compared with DTC telehealth visits, of which 28 percent resulted in a diagnosis requiring antibiotic prescriptions.

Thus, 28.9 percent of PCP-conducted telehealth visits resulted in antibiotic prescriptions compared to 37.2 percent of DTC telehealth appointments.

“Primary care telehealth is integrated with the patient’s ongoing in-person care, so PCPs providing telehealth visits have access to patients’ prior records, have ongoing patient-provider relationships and have the ability to bring the patient into the office if the child needs a test or to be examined more closely,” said senior author Kristin Ray, MD, associate professor of pediatrics at the Pitt School of Medicine and pediatrician at UPMC, in a news release. “Without these options, providers in virtual-only care settings might prescribe antibiotics ‘just in case’ more often, and they might perceive more pressure from parents to prescribe antibiotics in virtual-only settings.”

Further, the study shows that the rates of antibiotic management that were not concordant with guidelines were similar for PCP and DTC telehealth visits. Among PCP telehealth visits, non-guideline concordance was lower for visits conducted by pediatricians and higher for those conducted by family practitioners.

However, follow-up rates differed between PCP and DTC telehealth appointments. PCP telehealth visits had a 5 percent follow-up visit rate within the following one to two days versus an 8 percent follow-up visit rate for DTC telehealth visits.

“We looked at return visits as a potential signal of undertreatment such as a missed diagnosis or a complication,” said first author Samuel Wittman, research data analyst at the Pitt School of Medicine, in the press release. “If less use of antibiotics by PCPs was because of undertreatment, we would expect to see a higher follow-up rate. Instead, we saw lower follow-up in this group.”

Thus, researchers concluded that telehealth integrated within primary care may help reduce antibiotic use and follow-up visits, making a case for a telehealth policy that supports the ongoing integration of virtual tools into primary care.

The new research aligns with previous studies showing that DTC telehealth is associated with higher antibiotic prescriptions.

A study published in 2022 examined on-demand telehealth visits available to health system employees and their dependents at a large health system from March 2018 to July 2019. Antibiotics were prescribed in 23 percent of the 716 virtual visits during the study period.

The study shows that health system-employed physicians prescribed antibiotics in 18 percent of visits, while DTC telehealth-affiliated physicians prescribed antibiotics in 37 percent of visits. After adjusting for age, weekends, and overnight visits, patients seen by DTC telehealth-affiliated physicians had 2.3 higher odds of being prescribed antibiotics.