@article {635791, title = {Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits}, journal = {Pediatrics }, volume = {143}, number = {5}, year = {2019}, pages = {e20190631}, abstract = {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\ visitsby 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, 38 408 urgent care, and 485 201 PCP\ visits\ for ARIs in the matched sample.\ Antibioticprescribing\ 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.}, author = {Ray KN and Shi Z and Gidengil CA and Poon SJ and Uscher-Pines L and Mehrotra A} }