Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage

Abstract

Objective The objective of this research paper is to compare antibiotic treatment, follow-up rates, and types of follow-up encounters among eVisits, phone calls, and in-person encounters for pediatric conjunctivitis. Study design A retrospective chart review of pediatric patients evaluated for conjunctivitis between May 1, 2016 and May 1, 2017, was performed. A total of 101 eVisits, 202 in-person retail clinic visits, and 202 nurse phone calls for conjunctivitis were manually reviewed for outcomes. Exclusion criteria included previous encounter for conjunctivitis in the past 14 days, treatment with an oral antibiotic at the initial encounter, or patient outside Minnesota at the time of encounter. Comparison among the three encounter types with regard to follow-up rates, follow-up encounter type within 14 days of initial evaluation, and prescribing rates was performed. Results Patients completing non-face-to-face encounters were significantly more likely to have follow-up care (34.6% and 45.5%) than those who had a face-to-face visit at the retail clinic (7.4%), p ≤ 0.0001. Patients initially evaluated by eVisit were more likely to have follow-up at the retail clinic while patients initially evaluated by phone call were more likely to have follow-up in their primary care office. Treatment rates with antibiotics were significantly higher in phone call encounters (41.6%) than in eVisits (25.7%) or face-to-face encounters (19.8%), p < 0.0001. Conclusions Non-face-to-face visits have significantly higher rates of follow-up when compared to face-to-face encounters. Antibiotic prescribing is greater with phone call triage encounters; however, there was no significant difference in antibiotic prescribing rates between eVisits and face-to-face visits. Follow-up type varied according to site of initial encounter.

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

“…One study [ 24 ] found that e-visits resulted in higher antibiotic prescribing rates for sinusitis (471/475, 99% vs 4408/4690, 94%, P< .001) but no association for urinary tract infections (98/99, 99% vs 1299/2855, 92%, P= .07), compared to those for historical control. Another study [ 46 ] reported that e-visits for conjunctivitis resulted in a significantly lower antibiotic prescribing rate than that of phone visits (26/101, 26% vs 84/202, 42%, P= .006), and a third study [ 51 ] found that e-visits for sinusitis resulted in a significantly lower antibiotic prescribing rate (84/150, 56% vs 108/150, 72%, P= .01) than that of in-person visits. Lastly, one study (n=450) [ 50 ] reported no difference in antibiotic prescribing rates for treatment of urinary tract infections across e-visits, phone encounters, and in-person visits.…”

“…For example, one study [ 24 ] found that e-visits for sinusitis and urinary tract infections had equivalent rates of follow-up visits, phone calls, and emails within 3-week follow-up. Some studies [ 30 , 46 ] reported a higher rate of health care utilization with e-visits. For example, one study [ 30 ] found that the rate of follow-up visits was higher for primary care e-visits (59/490, 12%) compared to that for in-person visits (198/2201, 9%; P= .04).…”

Outpatient antibiotic prescribing for common infections via telemedicine versus face-to-face visits: Systematic literature review and meta-analysis

“…Of the 23 studies, 11 included only adults, 12,14-18,21,22,26,27,32 7 investigated both adults and children, 19,20,23,24,30,31,33 and 3 involved only children. 8,25,28 For telemedicine modalities, 17 studies evaluated synchronous video and/or phone visits, 8,12,[15][16][17][20][21][22][23][24][25][26][27][28][29]31,33 7 evaluated asynchronous text or internet visits, 7,14,18,[26][27][28][29] and 3 neither specified nor separated those 2 modalities. 19,30,32 Also, 16 studies evaluated clinic visits, 7,8,14,18-22,24,26-33 9 evaluated urgent care, 8,12,15,16,21,23,25,30,31 5 evaluated emergency departments, 17,19,…”

“…19,30,32 Also, 16 studies evaluated clinic visits, 7,8,14,18-22,24,26-33 9 evaluated urgent care, 8,12,15,16,21,23,25,30,31 5 evaluated emergency departments, 17,19,23,30,31 and 4 evaluated retail clinic visits. [26][27][28]30 The most commonly evaluated indication was sinusitis, which was reported in 10 studies, 7,8,15,18,[21][22][23]27,30,32 followed by upper respiratory infection (URI), which was reported in 6 studies, 8,12,16,21,22,30 urinary tract infection (UTI), which was reported in 5 studies, 7,14,19,26,30 pharyngitis, which was reported in 5 studies, 8,16,21,22,30 and otitis media, which was reported in 4 studies. 8,…”

“…8,16,21,22 Finally, 15 studies earned 18 points or more in the Downs and Black scale and therefore were considered high-quality studies (Supplementary Table 2 online). 8,12,14,[17][18][19][20][21]23,[26][27][28]30,31,33…”