Sick children were considerably more likely to be prescribed antibiotics if diagnosed through a telemedicine service, opposed to those who went to a doctor's office or clinic, according to a new study. Many of those prescriptions simply ignored medical guidelines, raising the risk of causing multiple side effects or possibly contribute to the rise of antibiotic-resistant germs.
"I understand the desire for care that's more convenient and timely," said the study's lead author, Dr. Kristin Ray of the University of Pittsburgh. "But we want to make sure that we don't sacrifice quality or safety or effectiveness in the process."
Ray and her colleagues studied more than 340,000 children who had acute respiratory illness medical visits between 2015 and 2016. Some of those children received prescriptions for antibiotics, more than half actually, during telemedicine visits, compared with 42 percent at urgent care clinics and 31 percent at doctors' offices. While overprescribing has been linked to germs building a resistance to antibiotics and eventually mutating into untreatable viruses, they can also raise medical bills and even cause serious side effects, said Tim Landers, an Ohio State University expert on antibiotic-resistant infections. "These are not harmless drugs," Landers said, who was not involved in the study.
The researchers also found that in looking at telemedicine doctors' decisions about whether to prescribe or not prescribe antibiotics, 40 percent of which failed to meet medical guidelines on matching treatment to diagnosis. It was mainly linked to doctors giving prescriptions for bacteria-fighting drugs to treat viral illnesses, such as colds and flus, that are normally unaffected by antibiotics. It was also noted that 30 percent of urgent care clinic decisions were inappropriate as well, and nearly 20 percent of doctors' office decisions were too.
Doctors and hospitals utilize this technology for consultations, but the study focused on direct-to-consumer telemedicine programs that anyone can call without, first, talking to their regular doctor. Only about one percent of the ill children in the study were seen through personal visits. The American Academy of Pediatrics encourages parents not to use such direct-to-consumer programs. Academy officials say limited physical examinations and lack of access to patient records can harm care.
But telemedicine seems to be on the rise, especially among employers who believe it can save money, said Jason Doctor, a University of Southern California health policy and economics researcher. Doctor is examining ways to improve antibiotic prescribing at telehealth firms. It's an important issue, he said, because "telemedicine is going to grow. It's going to become a more routine part of people's medical care."
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