New research suggests telemedicine provided by primary care practices could play a role in reducing unnecessary antibiotic prescribing in kids.
In a study published today in JAMA Network Open, a team led by researchers from the University of Pittsburgh School of Medicine found that telemedicine visits with primary care providers were associated with less antibiotic prescribing in children with acute respiratory tract infection (ARTI) than primary care in-person visits, with no increase in follow-up visits or subsequent antibiotic prescriptions. And the quality of prescribing was equal.
The findings are from an analysis of visits for ARTIs at 694 US family medicine primary care practices from October 2024 to February 2026. The researchers examined data from 438,148 in-person and 11,482 video visits by 302,817 children (mean age, 6.6 years; 51.4% boys). ARTIs account for most outpatient antibiotic prescriptions in kids, even though at least a third of those prescriptions are unnecessary.
After conducting a weighted analysis to balance the two groups, the researchers found that 34.6% of children at telemedicine visits were prescribed an antibiotic, compared with 48.6% of those who had in-person visits—a 12.1 percentage-point difference. Antibiotic prescriptions considered “guideline-concordant” were roughly equal, with 85.5% of prescriptions at telemedicine visits adhering to guidelines, compared with 86.2% at in-person visits.
The proportion of follow-up primary care visits for ARTI and subsequent antibiotic prescriptions within the following 14 days did not differ significantly between the two groups. That suggests that diagnoses weren’t being missed at telemedicine visits, which is one of the concerns expressed about being examined over a smartphone, tablet, or laptop.
The study authors suggest the results partly reflect the fact that the telemedicine visits had a larger proportion of patients receiving a viral diagnosis than in-person visits.
“Altogether, these results indicate judicious antibiotic prescribing during ARTI telemedicine visits integrated within primary care practices of varied types and location across the US,” they write.
Connection with provider may make a difference
The findings are noteworthy because in a previous study conducted by lead author Kristin Ray, MD, an associate professor of pediatrics and pediatrician at UMPC Children’s Hospital of Pittsburgh, antibiotic prescribing in children with ARTIs was found to be significantly higher in direct-to-consumer telemedicine visits than in-person visits.
Ray told CIDRAP News that she and her colleagues wanted to see if the results might be different with telemedicine offered by primary care providers.
“We suspected telemedicine might be used in different ways within primary care settings compared to the virtual urgent care contexts, which is why we thought this was an important question to ask,” Ray said in an email.
Ray said the reason for the difference could be that with video visits that are integrated into a primary care practice, patients are being connected with the clinicians that they would typically see for both well and sick visits.
“This means these visits are occurring with clinicians who can readily bring the patient into the office to complete the evaluation or to have timely follow-up, and who expect to see this child again the next time they are sick,” she said. “These factors may alter prescribing decisions.”
In an editorial that accompanies the study, pediatric infectious disease experts at the University of Washington and George Washington University School of Medicine and Health Sciences say the study “underscores the idea that telemedicine visits can represent a crucial tool for treating children with acute respiratory infections.”
…these visits are occurring with clinicians who can readily bring the patient into the office to complete the evaluation or to have timely follow-up, and who expect to see this child again the next time they are sick….These factors may alter prescribing decisions.
In addition to limiting unnecessary antibiotic use, they cite several other potential benefits of telemedicine, such as keeping sick children out of waiting rooms, which can reduce the spread of contagious illness; maintaining access to timely care for as many patients as possible; reducing greenhouse gas emissions by eliminating the need for travel; and potentially avoiding lost work time for caregivers.
“Telemedicine will remain a vital tool in the years to come, and clinics and health systems should develop standards and protocols to use telemedicine wisely, employ effective caregiver communications strategies to limit unnecessary antibiotic prescribing, and monitor their own use of antibiotics during these visits to ensure ongoing high-quality care,” they write.
