In a landmark study poised to transform pediatric healthcare delivery, researchers have discovered that children receiving primary care through telehealth visits are significantly less likely to be prescribed antibiotics for acute respiratory tract infections (ARTIs) compared to those seen in person. This compelling evidence, to be presented at the upcoming Pediatric Academic Societies (PAS) 2025 Meeting in Honolulu, offers new insights into the judicious use of antibiotics in a digital healthcare landscape increasingly shaped by the integration of telemedicine.
The study evaluated over half a million pediatric visits across 843 diverse U.S. primary care sites, spanning family and pediatric medicine practices. By meticulously analyzing electronic health records from 2023, the researchers focused on episodes of ARTI care, comparing initial telehealth (TM) visits and traditional in-person (IP) consultations. Their retrospective cross-sectional analysis identified a striking 12% reduction in antibiotic prescriptions during telehealth visits, suggesting that virtual care modalities may contribute to more prudent antibiotic stewardship without compromising guideline adherence.
Antibiotic overuse has long been a critical issue, especially in pediatrics, where inappropriate prescribing for viral respiratory infections contributes to the global threat of antimicrobial resistance. Previous concerns centered significantly on direct-to-consumer telemedicine platforms, where virtual urgent care settings reportedly showed higher rates of unnecessary antibiotic prescriptions. However, this new research distinguishes telehealth visits integrated directly within primary care practices as a separate and more effective model, demonstrating that antibiotics are prescribed in alignment with established clinical guidelines.
The data revealed that while telehealth accounted for a small percentage (2.3%) of all ARTI episodes, those visits resulted in a 16.3% antibiotic prescription rate, markedly lower than the 46.9% observed in-person. This discrepancy is attributable, in part, to the lower frequency of bacterial diagnoses made during telehealth appointments. For instance, acute otitis media, streptococcal pharyngitis, and sinusitis diagnoses were substantially less common in telehealth compared to in-person visits. Despite this, the rates of guideline-concordant antibiotic management were higher in telehealth visits—90.0% versus 85.9%—indicating more stringent adherence to protocols when prescribing antibiotics remotely.
Beyond prescription rates, the study also assessed patient outcomes post-initial visit. Interestingly, although children seen via telehealth had slightly higher follow-up visit rates within the subsequent two weeks, they did not receive significantly more antibiotic prescriptions during this period. This suggests that telehealth does not simply delay or defer antibiotic treatment but rather supports effective initial clinical decision-making, reducing unnecessary antibiotic use without adversely affecting patient health trajectory.
Dr. Samuel Wittman, MS, research data analyst at the University of Pittsburgh and presenting author, emphasized the practical implications of integrating telemedicine into pediatric primary care. "These findings show that when used in the context of a primary care practice, telehealth can allow primary care physicians to provide treatment that aligns with guidelines," Wittman explained. He highlighted that telehealth offers enhanced accessibility, particularly benefiting families facing transportation, financial, or time constraints, thereby democratizing access to appropriate pediatric care.
Methodologically, the study employed a robust logistic regression model with patient-level random intercepts to account for variation across practice sites and patient demographics. The researchers excluded well visits and cases with comorbid conditions warranting antibiotics to focus precisely on ARTI management. This rigorous approach ensured that comparisons between telehealth and in-person visits reflected true differences in prescribing behavior unaffected by extraneous factors.
This research arrives amid a broader shift driven by the COVID-19 pandemic, which catalyzed widespread telemedicine adoption across healthcare sectors. Many primary care practices have since integrated telehealth with in-person care, challenging physicians to maintain quality standards remotely. The study’s findings underscore that, contrary to earlier apprehensions, telehealth integrated within established primary care medical homes supports responsible antibiotic use rather than compromising it.
The implications extend beyond pediatrics, highlighting telemedicine’s potential role in combating antimicrobial resistance globally by reinforcing rational antibiotic prescribing practices. As antibiotic stewardship becomes an urgent public health imperative, these findings advocate for expanding telemedicine infrastructure coupled with clinical oversight to optimize healthcare delivery without sacrificing safety or efficacy.
Additionally, the study’s wide geographic scope and inclusion of diverse patient populations—48.3% insured via Medicaid and 10.8% from Spanish-speaking families—enhance the generalizability of results. This diversity underscores telehealth’s promise as an equitable tool in reducing healthcare disparities, enabling vulnerable communities to receive evidence-based care.
The data and conclusions further dispel the misconception that virtual care necessarily leads to overtreatment or reduced care quality. By systematically analyzing over half a million episodes of pediatric respiratory infections, the research provides a compelling counter-narrative, positioning telehealth as a critical component of modern, integrated primary care models.
In sum, this study elevates the discourse on pediatric telemedicine by presenting empirical evidence that telehealth, when embedded within primary care systems, fosters judicious antibiotic prescribing practices aligned with clinical guidelines. The research advocates for ongoing investments in telehealth infrastructure and provider training to harness its full potential in enhancing pediatric healthcare outcomes while addressing public health challenges like antibiotic resistance.
As health systems worldwide grapple with balancing accessibility, quality, and cost-effectiveness, this work offers a timely exemplar of how thoughtful integration of telemedicine not only maintains but potentially enhances antibiotic stewardship. The forthcoming presentation by Samuel Wittman at the PAS Meeting will undoubtedly stimulate informed discussions by clinicians, researchers, and policymakers striving for evidence-based innovation in child and adolescent health.
Subject of Research: Antibiotic prescribing patterns during telemedicine versus in-person primary care visits for pediatric acute respiratory tract infections.
Article Title: Antibiotic Receipt During Primary Care Telemedicine Versus In-Person Visits for Pediatric Acute Respiratory Tract Infections, 2023.
News Publication Date: Not specified (scheduled presentation in April 2025).
Web References:
- Pediatric Academic Societies Meeting: www.pas-meeting.org
- PAS Meeting Twitter: https://x.com/PASMeeting
- PAS Meeting Facebook: https://www.facebook.com/PASMeeting/
Keywords: Pediatrics, Acute Respiratory Tract Infections, Telemedicine, Antibiotic Stewardship, Antimicrobial Resistance, Primary Care, Pediatric Infectious Diseases, Healthcare Accessibility, Clinical Guidelines, Health Disparities, COVID-19 Pandemic, Electronic Health Records.
