Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits
Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits
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DOI：
10.1542/peds.2018-2491
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发表时间：
2019-05-01
期刊：
影响因子：
8
通讯作者：
Mehrotra, Ateev
中科院分区：
文献类型：
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作者：
Ray, Kristin N.;Shi, Zhuo;Mehrotra, Ateev
使用索赔从一个大型的国家商业健康计划，我们研究抗生素处方急性呼吸道疾病在儿科DTC远程医疗访问。背景和说明：儿童在儿科医疗之家外使用商业直接面向消费者（DTC）远程医疗的情况越来越多，急性呼吸道感染（阿里斯）是DTC远程医疗就诊时最常见的诊断情况。我们的目的是比较儿童阿里斯抗生素处方的质量在3个设置：DTC远程医疗，紧急护理，和初级保健提供者（PCP）office.METHODS：在回顾性队列研究中，使用2015-2016年索赔数据从一个大型的国家商业健康计划，我们确定了ARI访问的儿童（0-17岁），不包括访问的合并症，可能会影响抗生素的决定。访问匹配的年龄，性别，慢性疾病的复杂性，状态，农村，健康计划的类型，和ARI诊断类别。在匹配的样本中，我们比较了ARI访问与任何抗生素处方的百分比和ARI访问与指南一致的抗生素management.Results的百分比：有4604 DTC远程医疗，38408紧急护理，和485201 PCP访问阿里斯在匹配的样本。DTC远程医疗就诊的抗生素处方高于其他情况（DTC远程医疗就诊的52%，紧急护理的42%和PCP就诊的31%;两种比较的P <0.001）。DTC远程医疗访视时指南一致性抗生素管理低于其他环境（DTC远程医疗访视59%，紧急护理67%，PCP访视78%;两项比较P < .001）。结论：DTC远程医疗访视时，与PCP访视和紧急护理访视时的儿童相比，阿里斯儿童更有可能接受抗生素治疗，而接受指南一致性抗生素管理的可能性较小。
Using claims from a large national commercial health plan, we examine antibiotic prescribing for acute respiratory illnesses during pediatric DTC telemedicine visits. BACKGROUND AND OBJECTIVES:Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office.METHODS:In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.RESULTS:There were 4604 DTC telemedicine, 38408 urgent care, and 485201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons).CONCLUSIONS:At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.