Monday Rx | April 8, 2019 | Does Telemedicine Have a Downside?
The Other Side of Telemedicine
Telemedicine may be leading to the overprescribing of antibiotics to sniffling children, a new study suggests.
Kids with cold symptoms seen via telemedicine visits were far more likely to be prescribed antibiotics than those who went to a doctor’s office or clinic, researchers found. And a higher proportion of those prescriptions disregarded medical guidelines, raising the risk they could cause side effects or 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.”
The study was published Monday in the journal Pediatrics.
Ray and her colleagues looked at more than 340,000 insured children who had acute respiratory illness medical visits in 2015 and 2016.
Children received prescriptions for antibiotics more than half the time during telemedicine visits, compared with 42% at urgent care clinics and 31% at doctors’ offices.
While overprescribing can help germs build resistance to antibiotics and mutate into untreatable superbugs, they also can add a needless cost to 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, 4 out of 10 failed to meet medical guidelines on matching treatment to diagnosis. That mainly had to do with doctors prescribing bacteria-fighting drugs to treat viral illnesses, such as colds and flus, that are unaffected by antibiotics.
In comparison, 3 out of 10 urgent care clinic decisions were inappropriate, and about 2 out of 10 doctors’ office decisions were.
The researchers also found telemedicine physicians appeared to be ignoring other guidelines. For example, doctors are supposed to take a throat swab and run a lab test before diagnosing strep throat. But that rarely happened in telemedicine visits, Ray said.
A large recent study on antibiotic prescribing patterns for adults found little difference between telemedicine and office visits. But there has been little study of the issue in children.
During telemedicine visits, patients interact with doctors and nurses through video or audio calls. They can be less expensive and easier than trying to get in at a pediatrician’s office or hauling kids to an urgent care center.
Some doctors and hospital systems use the technology for consultations, but the study focused on direct-to-consumer telemedicine programs that someone can call up without talking to their regular doctor. Only about 1 percent of the sick kids in the study were seen through such visits.
The American Academy of Pediatrics, which publishes the journal, 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 catching on, especially among employers who believe it can save money, said Jason Doctor, a University of Southern California health policy and economics researcher. I’d like to hear from our pediatricians on this study and related outcomes.
LA County DPH Partnership
Happy to report that LACMA has wonderful partnership with the Los Angeles County Department of Public Health as we jointly tackle several public health issues such as vaping. The rise in vaping county wide has been staggering. BREATHE California of Los Angeles has led the fight against unscrupulous marketing to teens and even pre teens by so-called legitimate companies like JUUL. BREATHE LA is also on the forefront of providing education on the fight against asthma, lung disease and COPD. If you would like to join our coalition let me know.
Diversity and Inclusion TAC
CMA is currently seeking nominations of physicians interested in participating in the Diversity and Inclusion TAC, which was launched in 2014 to usher in a new generation of policies and initiatives. CMA is seeking nominations of diverse physicians from all modes of practice, geographic regions, specialties and perspectives. CMA’s committees and councils provide key input to the Board of Trustees to guide the association as it sets new policies. The Diversity and Inclusion TAC will assist the board in implementing the Diversity and Inclusion Strategic Plan, which includes strategy on leadership development.
It is estimated that there will be one in person meeting and a minimum of three virtual meeting of this TAC over the next year.
Sexual Harassment Training
LACMA’s preferred partner, Workwise Law is excited to announce their sexual harassment prevention traininghas gone live on their website this week! The law changed this year: If practices have 5 or more employees in the state of California, they must provide 1 hour of training to employees and 2 hours of training to supervisors/managers by the end of 2019! The Workwise Law online training is $35 for employee and $70 for supervisors. Workwise Law also provides trainings at your workplace.
For those who’ve accessed the “Getting & Staying In Compliance” or “Premium Coverage & Support” Packages, members are entitled to this training and Workwise Law will send you the access codes to get your staff trained, or will arrange a live training.
2019 LACMA Membership Survey
A significant percentage of respondents to our recent survey said they are not fully aware of the 20+ benefits available to them through membership.
We’d love to hear back from more of you. If you have yet to fill out the survey, please do so to help us improve the member experience.
Once you’ve completed the survey, please email Chinaza Osisioma with your name and phone number to enter the drawing.
Drawing will be held no later than April 12th, 2019.
EVENTS AND COMMUNITY
Registration is now open for the 45th annual California Medical Association Legislative Advocacy Day.
Attendees will have the opportunity to discuss health care with legislators at the Capitol. Meetings are scheduled and coordinated by local county medical societies.
This unique event is free of charge to all CMA (and LACMA) members. Plan to join more than 400 physicians, medical students and resident members in educating legislative leaders as champions for patients and the practice of medicine.
WHEN: Wednesday, April 24, 2019
WHERE: Sacramento Convention Center
1400 J St.,
Sacramento, CA 95814Click here for full details.