In the Journals

Pediatricians less likely than non-pediatricians to prescribe antibiotics via telemedicine

Photo of Charles B. Foster
Charles B. Foster

Physicians were more likely to receive a five-star satisfaction rating on a direct-to-consumer, or DTC, telemedicine platform when they prescribed antibiotics for pediatric respiratory tract infections, or RTIs. Researchers noted that pediatricians were less likely to prescribe antibiotics than other clinicians, yet had higher satisfaction ratings.

Charles B. Foster, MD, a staff physician in the center for pediatric infectious diseases at the Cleveland Clinic Children's, told Infectious Diseases in Children that it is unclear why pediatricians were less likely to prescribe antibiotics.

“One possibility is that pediatricians spent more time with their patients,” he said. “Encounters with a pediatrician were 1.04 minutes longer than encounters with a non-pediatrician. If you don’t give an antibiotic, you may need to take the time to reassure the parent that their child is not seriously ill and that seeking medical care was appropriate.”

Foster and colleagues conducted a retrospective review of data collected from 12,842 DTC telemedicine encounters with 560 physicians for RTIs through a nationwide telemedicine platform. More than half of the encounters (55%) ended with the patient receiving a prescription for antibiotics, they reported.

According to the researchers, parents were more likely to give a physician a five-star rating when antibiotics were prescribed for their child (93.4%) compared with encounters in which no antibiotics were prescribed (80.8%). Furthermore, Foster and colleagues wrote that consults ending with antibiotic prescription often resulted in five-star ratings (OR = 3.38; 95% CI, 2.84-4.02). The same was true for antiviral treatment (OR = 2.56; 95% CI, 1.81-3.64) or another medication that was not an antibiotic (OR = 1.93; 95% CI, 1.58-2.36).

Five-star ratings also were associated with visit length, with longer encounters resulting in a higher rating when children were not prescribed antibiotics (OR = 1.03 per 6 seconds; 95% CI, 1.01-1.06).

Pediatricians were less likely to prescribe antibiotics for RTIs compared with physicians in other specialties (OR = 0.44; 95% CI, 0.29-0.68) but received higher encounter satisfaction ratings on the DTC telemedicine platform (OR = 1.50; 95% CI, 1.11-2.03).

“It’s important that providers who treat children be aware of the principles of judicious antibiotic prescribing for upper respiratory tract infections and provide care concordant with national guidelines,” Foster said. “For example, the guidelines recommend that children with pharyngitis should only be treated for strep throat if a throat swab is positive. You really can’t make that diagnosis without swabbing the child’s throat. Telemedicine providers can triage patients during the video conference. Those in need of throat cultures should be referred to an urgent care center for a throat swab.”

According to Eli Spreecher, MD, MPP, and Jonathan A. Finkelstein, MD, MPH, from Boston Children’s Hospital and Harvard Medical School, this research highlights the benefits of telemedicine, as well as the risk for overuse of antimicrobial agents in the outpatient setting.

“The high rates of antibiotic prescribing may be the result of real or perceived desires of parents, differences in the cases or different decisions by physicians who use physical examination to reject a diagnosis of bacterial illness,” they wrote in a related editorial. “We believe all are likely at play. The differential prescribing rates between pediatricians and other physicians suggest that there may be a comfort level with not treating that comes with pediatric experience. Understanding what drives patient satisfaction may guide the development of best practices for clinicians of all specialties working in the digital environment.” – by Katherine Bortz

References:

Foster CB, et al. Pediatrics. 2019;doi:10.1542/peds.2019-0844.

Sprecher E, Finkelstein JA. Pediatrics. 2019;doi:10.1542/peds.2019-1585.

Disclosures: The authors report no relevant financial disclosures.

Photo of Charles B. Foster
Charles B. Foster

Physicians were more likely to receive a five-star satisfaction rating on a direct-to-consumer, or DTC, telemedicine platform when they prescribed antibiotics for pediatric respiratory tract infections, or RTIs. Researchers noted that pediatricians were less likely to prescribe antibiotics than other clinicians, yet had higher satisfaction ratings.

Charles B. Foster, MD, a staff physician in the center for pediatric infectious diseases at the Cleveland Clinic Children's, told Infectious Diseases in Children that it is unclear why pediatricians were less likely to prescribe antibiotics.

“One possibility is that pediatricians spent more time with their patients,” he said. “Encounters with a pediatrician were 1.04 minutes longer than encounters with a non-pediatrician. If you don’t give an antibiotic, you may need to take the time to reassure the parent that their child is not seriously ill and that seeking medical care was appropriate.”

Foster and colleagues conducted a retrospective review of data collected from 12,842 DTC telemedicine encounters with 560 physicians for RTIs through a nationwide telemedicine platform. More than half of the encounters (55%) ended with the patient receiving a prescription for antibiotics, they reported.

According to the researchers, parents were more likely to give a physician a five-star rating when antibiotics were prescribed for their child (93.4%) compared with encounters in which no antibiotics were prescribed (80.8%). Furthermore, Foster and colleagues wrote that consults ending with antibiotic prescription often resulted in five-star ratings (OR = 3.38; 95% CI, 2.84-4.02). The same was true for antiviral treatment (OR = 2.56; 95% CI, 1.81-3.64) or another medication that was not an antibiotic (OR = 1.93; 95% CI, 1.58-2.36).

Five-star ratings also were associated with visit length, with longer encounters resulting in a higher rating when children were not prescribed antibiotics (OR = 1.03 per 6 seconds; 95% CI, 1.01-1.06).

Pediatricians were less likely to prescribe antibiotics for RTIs compared with physicians in other specialties (OR = 0.44; 95% CI, 0.29-0.68) but received higher encounter satisfaction ratings on the DTC telemedicine platform (OR = 1.50; 95% CI, 1.11-2.03).

“It’s important that providers who treat children be aware of the principles of judicious antibiotic prescribing for upper respiratory tract infections and provide care concordant with national guidelines,” Foster said. “For example, the guidelines recommend that children with pharyngitis should only be treated for strep throat if a throat swab is positive. You really can’t make that diagnosis without swabbing the child’s throat. Telemedicine providers can triage patients during the video conference. Those in need of throat cultures should be referred to an urgent care center for a throat swab.”

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According to Eli Spreecher, MD, MPP, and Jonathan A. Finkelstein, MD, MPH, from Boston Children’s Hospital and Harvard Medical School, this research highlights the benefits of telemedicine, as well as the risk for overuse of antimicrobial agents in the outpatient setting.

“The high rates of antibiotic prescribing may be the result of real or perceived desires of parents, differences in the cases or different decisions by physicians who use physical examination to reject a diagnosis of bacterial illness,” they wrote in a related editorial. “We believe all are likely at play. The differential prescribing rates between pediatricians and other physicians suggest that there may be a comfort level with not treating that comes with pediatric experience. Understanding what drives patient satisfaction may guide the development of best practices for clinicians of all specialties working in the digital environment.” – by Katherine Bortz

References:

Foster CB, et al. Pediatrics. 2019;doi:10.1542/peds.2019-0844.

Sprecher E, Finkelstein JA. Pediatrics. 2019;doi:10.1542/peds.2019-1585.

Disclosures: The authors report no relevant financial disclosures.