Telemedicine overprescribes antibiotics: Are you really receiving the best care over the phone?

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You’ve seen the ads, and you may have even gotten a flyer in the mail directly from your insurance company. Use an app to make a quick video call to get the medical care you need. No waiting rooms, no appointments, no having to be touched, or even sit in a room with a physician – just the magic of the internet, and you’ll get what you want.

But will you get what you need?

study published in Pediatrics showed that pediatric remote telehealth visits are far more likely to result in an antibiotic prescription than an in-person visit with a doctor. Researchers looked at a total of about 500,000 visits for acute respiratory symptoms (typically common colds) from 2015-2016, matching visits by things like age, medical complexity, location, and the diagnosis. They then looked to see how many of the encounters resulted in an antibiotic prescription, separating out telehealth, urgent care, and primary physician visits. By telemedicine, here, they looked only at direct-to-consumer telemed visits, the kind you’ve seen advertised by private companies, and promoted by your insurance.

Before we look at the numbers, let’s ask: How many of these visits should have resulted in an antibiotic prescription? Among respiratory diagnoses, infections that typically “need” antibiotics include strep pharyngitis, otitis media (ear infections), sinusitis, and pneumonia. By the way, even these infections don’t necessarily always need an antibiotic – in many cases, they’ll improve just fine and just as quickly without a prescription. But for a generous benefit of the doubt, let’s assume all visits with these diagnoses should have ended with an antibiotic prescription, and that visits for diagnosis with a viral cause should not have resulted in an antibiotic.

The study found that among all of the visits examined that had a clear-cut diagnostic code, 27% were for a diagnosis that should typically result in an antibiotic prescription. Keep that figure in mind – 27% of these encounters, to fit within well-established, evidence-based guidelines, should have had an antibiotic prescribed. The other 73% were for viral infections (almost all of these were for common colds.)

So how did the groups do in this study? Primary care physicians prescribed antibiotics 31% of the time/ That’s pretty darn close to 27%, so good on them. Urgent care centers didn’t do quite as well in meeting the guidelines, prescribing antibiotics at 42% of visits. And the telemed visits did the worst, prescribing antibiotics 52% of the time, about twice as often as they should.

Why should anyone care? Antibiotic overuse is a huge problem. On a community level, we’re creating legions of superbugs becoming resistant to ordinary antibiotics. We’re also risking C. difficile colitis, allergic reactions, and other health problems. But worst of all, to me, is that these antibiotic prescriptions create a creepy, self-fulfilling over-reliance on prescription medications. In a way, overprescribing is a good business model – it leads to repeat business, as your patients grow to expect to need a prescription for every cough. But it’s certainly not helping anyone become healthier.

Telemedicine is here. I get flyers directly from my insurance company, encouraging me to try it out instead of visiting my doctor. It’s quick, it’s easy, and it’s cheaper for the insurance company. They love it. And I think telemed does have a role for diagnosing and treating some health problems (especially mental health issues or follow-ups that don’t require a physical exam.) But the way it’s commonly done now isn’t delivering good care. We need to figure out the best way to deliver quality medicine via telehealth platforms – not medicine that’s cheap, quick, and harmful.

Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.

Image credit: Shutterstock.com

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