Study: Telehealth in pediatric primary care supports judicious antibiotic prescribing

(Press-News.org) Children treated with primary care telehealth visits were less likely to receive antibiotics for acute respiratory tract infections than those examined in person, according to a new study. The research will be presented at the Pediatric Academic Societies (PAS) 2025 Meeting, held April 24-28 in Honolulu. 

While providers prescribed 12% fewer antibiotics during initial primary care telehealth visits compared to in-person appointments, both settings had similarly high rates of following established guidelines, according to researchers. In the two weeks after the initial visit, children who had a telehealth visit received no more antibiotics than those who had an in-person visit.

“These findings show that when used in the context of a primary care practice, telehealth can allow primary care physicians to provide treatment that aligns with guidelines,” said Samuel Wittman, MS, research data analyst at the University of Pittsburgh and presenting author. “Integrating telehealth into pediatric primary care allows pediatricians more options for getting children connected to the right care at the right time, especially for families with time, transportation, or financial barriers.”

Previous studies found potential overprescription of respiratory infection treatment during telehealth visits in virtual urgent care settings, authors noted, leading them to study its use in the primary care medical home specifically.

The findings show potential value—and allay fears—about integrating telehealth within primary care. Appropriate prescribing ensures quality antibiotic management and reduces the risk of contributing to antimicrobial resistance, authors said.

The national study analyzed more than 540,000 pediatric visits for acute respiratory tract infections across 843 U.S. pediatric and family primary care sites.

# # #

EDITOR:
Samuel Wittman will present “Antibiotic Receipt During Primary Care Telemedicine Versus In-Person Visits for Pediatric Acute Respiratory Tract Infections, 2023” on Sun., April 27 from 8:00-8:15 PM ET. 
Reporters interested in an interview with Samuel should contact Amber Fraley at amber.fraley@pasmeeting.org.
The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit www.pas-meeting.org.

About the Pediatric Academic Societies Meeting
Pediatric Academic Societies (PAS) Meeting connects thousands of leading pediatric researchers, clinicians, and medical educators worldwide united by a common mission: Connecting the global academic pediatric community to advance scientific discovery and promote innovation in child and adolescent health. The PAS Meeting is produced through the partnership of four leading pediatric associations; the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). For more information, please visit www.pas-meeting.org. Follow us on X @PASMeeting and like us on Facebook PASMeeting.

Abstract: Antibiotic Receipt During Primary Care Telemedicine Versus In-Person Visits for Pediatric Acute Respiratory Tract Infections, 2023

Presenting Author: Samuel Wittman, MS

Organization
University of Pittsburgh

Topic
Telemedicine

Background
Since the telemedicine policy changes that occurred with the COVID-19 pandemic, many primary care practices have integrated telemedicine (TM) along with in-person (IP) visits. Previous work raised concerns about the quality of antibiotic management for pediatric acute respiratory tract infections (ARTis) in direct-to-consumer telemedicine visits, which occur with virtual-only vendors. However, emerging data from single health systems suggest antibiotic prescribing may be more judicious when TM is integrated within primary care practices.

Objective
To compare antibiotic management during TM and IP visits for ARTis among children within heterogenous primary care practices.

Design/Methods
We performed retrospective, cross-sectional analyses of 2023 electronic health record data from 843 U.S. pediatric and family medicine primary care sites with diverse geography and patient populations. We identified TM and IP visits by children < 18 years for bacterial and viral ARTis and constructed episodes of care, defined as an index visit (visit with no ARTI visit in prior 21 days) and any follow-up visits (visits in subsequent 14 days). We compared antibiotic receipt, diagnoses, guideline concordant antibiotic management, and follow-up care for episodes with TM vs IP index visits. We used logistic regression with patient level random intercepts to test the significance of differences.

Results
We analyzed 540,607 ARTI episodes, after excluding episodes where the index visit was a well visit (7%) or had co-diagnoses that could warrant antibiotics (3%; Figure 1). Episodes were 48.3% for children insured by Medicaid, 10.8% with Spanish-speaking families, and 2.3% via TM (Table 1). Compared to IP index visits, TM index visits were less likely to receive an antibiotic prescription (16.3% TM vs 46.9% IP, p<.001) and less likely to receive bacterial diagnoses (13.3% TM vs 44.4% IP, p<.001). Of bacterial diagnoses, acute otitis media was diagnosed most often (5.4% TM; 26.4% IP), then streptococcal pharyngitis (4.4% TM; 13.2% IP) and sinusitis (3.6% TM; 4.8% IP). TM index visits had slightly higher rates of guideline concordant antibiotic management (90.0%) than IP index visits (85.9%, p<.001). In the 14 days after the index visit, TM index visits had higher rates of follow-up visits, but did not have significantly more subsequent antibiotic prescriptions (1.9% TM vs 3.7% IP, p=.15).

Conclusion(s)
Despite concerns about antibiotic prescribing for children via TM with direct-to-consumer virtual-only vendors, we found evidence of judicious antibiotic prescribing for children during TM integrated within primary care practices.

Tables and Images
Figure 1. Flow Diagram of Included Episodes
Table 1. Index Acute Respiratory Tract Infection Visit Characteristics
Table 2. Acute Respiratory Tract Infection Episode Outcomes, by Index Visit Modality

END